Name*

Name (Katakana)*

Gender*
MaleFemale

Date of Birth (Applicant)*

Email Address

Phone Number*

Postal Code*

Prefecture*

City/Town/Village*

Address (Street and beyond)*

Building Name/Room Number (if applicable)

High School or Previous School Name*

Graduation Year*
—Please Select from Below—High school seniorsHigh school sophomoresFirst-year high school studentsNon-high school students

Desired Department/Faculty/Course*
Department of Sports and HealthDepartment of Emergency Medical TechnologyDepartment of Clinical EngineeringDepartment of Judo TherapyNone of the above