SIL Sapporo Nihongo Gakko

Homestay Application

The personal information collected from the following application form should be used only for the management of the application.

Applicants from Chinese character using countries should write in Chinese as well.

As I start my homestay I agree to the following conditions:

to promptly compensate the host family for any damaged items;
to do all my own cleaning and washing;
to help out in the homestay family's house;
not to make phone calls using the homestay family's phone;
not to use the homestay family's computer;
to discuss curfew, phone rules, garbage rules and any other rules on my first day, and observe them;
to let the mother know if I will not be having dinner with the family or if I will be late for dinner;
to let SIL know if I have any problems regarding food or other matters;
I understand that the homestay is for the benefit of my Japanese learning. I will stay with the host family only while I take the intensive course at SIL.

I would like to apply for homestay 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:

Present School or Job Status (Include name of company or university and year):

Educational Background (Name of last school attended and date of graduation):

What are your interests and hobbies?

Favorite sporting activities:

Would you be comfortable in a home that permits smoking?
Yes No

Do you smoke?
Yes No

Would you be comfortable in a home that has pets?
Yes No

Please list any allergies (food, medicine, animals ...)

Please list any dietary restrictions you may have:

Please describe any specific health problems you may have:

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:

Please tell your Japanese host about your character, personality, and anything else they should know about you:

Applicants from Chinese character using countries should write in Chinese as well.

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