* Applying for an exchange during:
(留学希望の期間): |
|
| * Flexibility (留学期間変更可能): |
|
| * Type of Exchange (留学のタイプ): |
|
| * Country of Exchange: (留学希望の国) |
|
Applying to host a student in our home during the following time: (for reciprocal exchanges only) 留学生のホストを希望する期間 (相互留学のみ): |
|
| * Street Address (番地): |
|
| * City (市町村): |
|
| State (if USA): |
|
| * Postal Code (郵便番号): |
|
| * Country (国): |
|
* Citizenship
(国籍(パスポートを持っている国)): |
|
| * City of Birth (出生地(市町村)): |
|
| * Country of Birth (出生地(国)): |
|
* Legal Resident of (Country)
(居住国): |
|
* Nearest International Airport
(最寄の空港): |
|
| * Home Phone (自宅の電話番号): |
|
* Alternate/Emergency Phone
(緊急連絡先): |
|
| * Email: |
|
| Fax: |
|
| Father's Name (父親の名前): |
|
Father's Work Phone (父親の仕事先電話番号): |
|
| Mother's Name (母親の名前): |
|
Mother's Work Phone (母親の仕事先電話番号): |
|