2021年度 別科日本語研修課程入学試
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月Month年Year月Month年Year年Year円Yen円Yen月Month年Year円Yen年Year円Yen円Yen円Yen円Yen円Yen【様式 Form E-2】(携行者 Name of the individual carrying cash(3)経費支弁者(複数人いる場合は全てについて記入すること。)※任意様式の別紙可□卒業□中学校(3)電話番号□在学中In school□休学中□小学校(3)卒業又は卒業見込み年月Date of graduation or expected graduation(2)級又は点数Attained level or score月からMonth月からMonth□在外経費支弁者負担円□外国からの送金Yen□中退□短期大学Junior college□その他 ()□その他電話番号Telephone No.電話番号Telephone No.□専門学校までまで)申請人等作成用 2  P (「留学」)For applicant, part 2 P ("Student") 21 通学先Place of study(1)名 称(2)所在地Address22 修学年数 (小学校~最終学歴)23 最終学歴 (又は在学中の学校)Education (last school or institution) or present school(1)在籍状況□高等学校(2)学校名24 日本語能力 (専修学校又は各種学校において日本語教育以外の教育を受ける場合に記入)□日本語教育を受けた教育機関及び期間Organization and period to have received Japanese language education機関名Organization期間:Periodfrom□その他25 日本語学習歴 (高等学校において教育を受ける場合に記入)機関名Organization 期間:Periodfrom26 滞在費の支弁方法等(生活費,学費及び家賃について記入すること。)※複数選択可□在日経費支弁者負担□その他(2)送金・携行等の別Remittances from abroad or carrying cash□外国からの携行Carrying from abroadSupporter(If there is more than one, give information on all of the supporters )*another paper may be attached, which does not have to use a prescribed format.①氏 名②住 所Address③職業 (勤務先の名称)④年 収Name of school〒259-1292 神奈川県平塚市北金目4-1-1 Total period of education (from elementary school to last institution of education)Registered enrollment□大学院 (博士)□大学院 (修士)□大学DoctorSenior high schoolName of the school Japanese language ability (Fill in the followings when the applicant plans to study at advanced vocational school or vocational school (except Japanese language))□試験による証明Proof based on a Japanese language test(1)試験名Name of the testOthers Japanese education history (Fill in the followings when the applicant plans to study in high school) 日本語の教育又は日本語による教育を受けた教育機関及び期間 Organization and period to have received Japanese language education / received education by Japanese languageMethod of support to pay for expenses while in Japan(fill in with regard to living expenses, tuition and rent) * multiple answers possible(1)支弁方法及び月平均支弁額Method of support and an amount of support per month (average)□本人負担SelfSupporter in JapanOthersNameOccupation (place of employment)Annual incomeGraduatedMasterJunior high school携行時期Date and time ofcarrying cashTelephone No.Temporary absenceBachelorElementary schooltotoSupporter living abroad□奨学金ScholarshipRemittances from abroadWithdrawalOthersOthers在留資格認定証明書用 For certificate of eligibilityCollege of technology東海大学(湘南校舎)0463-58-1211年Years

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