Entry Form for Special Summer Program for ICU by Asian Rural Institute

are required fields.

Name *
(Last) (First)

Katakana name *
(Last) (First)

Nickname

ICU student ID (6 figures) *
　　

Major/minor (if any)
　　

Sex * This field is for room arrangement (male/female rooms).
MaleFemale

Date of birth (yyyy/mm/dd) (sample: 19870913) *
(Click year/month/date to enter or click calendar mark to select.)

Zip code *
－
Address in Japan *

Telephone number (figures only; sample: 0287363111) *

Emergency contact (figures only; sample: 0287363111) *
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Email *

Email confirmation *

How did you know this program? Multiple choice allowed (With PC, Ctrl+click).
​PosterFlyerAcquaintanceARI StaffOther
Detail

0

What about ARI are you interested in? Multiple choice allowed (With PC, Ctrl+click).
​Organic agricultureInternational relationsSustainabilityCommunity lifeOther

Motivation of entry (around 150 characters) *
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​0

Hobbies and special skills
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Do you need any special care such as food restrictions and physical conditions?
​YesNo

If "yes," what do you need?
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Do you want newsletters from ARI? *
​YesNo

Questions and remarks
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