SIL Sapporo Nihongo Gakko

Weekly Apartment Application

As I start my apartment stay I agree to the following conditions:

to pay the full fee in advance;
to dispose of each kind of garbage (burnable/non-burnable) on the designated day;
to keep the apartment clean and remove all trash;
to pay the full cost of any damaged items;
I understand that the apartment is for the benefit of my Japanese learning and that only the person/persons who signed the contract to stay in the room are allowed to stay.

I would like to apply for an apartment stay during:

Notes:

cf.Courses page

Name:

male female

Date of Birth:

Nationality:

Current Mailing Address (Include street, city, postal code, and country):

Phone Number:

Fax Number:

E-mail Address:

In the event of an emergency, please provide us with your parent's (or other) names, address, and phone number:

Arrival date and time:
Departure date and time:

Room type:

I would like a room with a Futon.
I would like a room with a refrigerator.
I would not like to borrow any kitchen utensils.

Rental items: Check the items you would like to rent.

	Item	Cost
	Microwave Oven	\2,000
	Bed	\2,000
	Table and chairs	\2,000
	Toaster Oven	\1,000
	TV	\1,000
	Plastic Drawers	\1,000

Please be sure to click the submit button once after filling in the form and send the appropriate application fee and a photo to SIL.
If you have trouble emailing this application, print it out and mail to SIL with your application fee.

SIL Sapporo Nihongo Gakko
Director & Instructor Ms. Harumi Shima
Bell Idaimae 1F, 291 Nishi 18 chome Minami 2 jo Chuo ku
Sapporo JAPAN 060-0062 Tel/Fax: 81-011-614-1101
E-mail: info@silnihongo.com