Full Name *

AS SHOWN IN PASSPORT

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have previous experience studying abroad? *

Yes

No

Have you taken an English Proficiency Exam?

IELTS, Oxford English Level Test, TOEFL

Yes

No

Who will be your financial sponsor during your studies in Japan? *

Parents/Relatives

Self-funded

Other

Sponsor's Name *

First Name

Last Name

Sponsor's Phone Number *

Country

(###)

###

####

How will your sponsor fund your studies? *

Savings

Loan

Other (please indicate below)

How did you hear about the Archipelago Semester Abroad Program? *

School/University

Social Media

Website

Referral

Acknowledgment *

I hereby declare that all the information provided is true and correct to the best of my knowledge. I understand that any false information may result in the rejection of my application.