Kyoto Consortium for Japanese Studies -Princeton University

Kyoto Consortium for Japanese Studies -Princeton University Exchange Program Application Form

Please attach the following items: Home University  Transcript  Letter of reference Application for: Fall Spring Semester: Full Academic Year:  Resume Semester: (check one)  TOEFL or other proof of English language ability  2 passport-size photos Year 20 -20

I. Personal Data (print or type) Name: Date of Birth: / / Last First Middle Month Day Year

City and Country of Gender: Male Female Citizenship: Birth: Grade Point Average: Expected Graduation Date:

Major: Minor: TOEFL Score: Date Taken:

All universities attended: Dates attended:

Dates attended: A. Current Address B. Permanent Address:

(Street or Building Name / Apt. or Box #) (Street or Building Name / Apt. or Box #)

(City, State or Country / Mailing Code) (City, State or Country / Mailing Code)

(Telephone) (Telephone)

(Fax) (Fax)

(E-mail if available) (E-mail if available)

Dates in residence: from / / to / / Dates in residence: from / / to / /

C. Summer Address (if different from permanent address) D. Emergency Contact

(Street or Building Name / Apt. or Box #) (Full Name / Relationship)

(City, State or Country / Mailing Code) (City, State or Country / Mailing Code)

(Telephone) (Home Telephone) (Work or Daytime Telephone)

Dates in residence: from / / to / / II. Billing Information Exchange students will be billed for room and board and for the Princeton University Student Health Plan. (Exchange students are required to enroll in the Princeton University Student Health Plan if they do not have comparable coverage by a carrier that is domiciled in the United States.)

(Person responsible for payment – Full Name / Relationship) (Home Telephone)

(Street or Building Name / Apt. or Box #) (Work or Daytime Telephone)

(City, State or Country / Mailing Code) (e-mail if available)

III. Academic Information A. List the faculty member you have asked to complete a letter of recommendation:

(Name) (Title)

(Address)

B. List any courses in which you are currently C. List the courses you would like to take in your first enrolled which do not appear on your transcript: semester at Princeton if they are available:

IV. Personal Statement 1. Please answer the following questions on a separate sheet of paper. Respond to each question in one or two well-formed paragraphs and limit the total length of your response to two pages.  Write a brief autobiographical sketch. You may wish to include highlights of your personal history, family background, work experience, travel experience, and other factors that have influenced your personal development.  Describe the goals (academic, professional, personal) that you hope to meet by studying abroad. How will this particular program and location be especially helpful?  What challenges do you anticipate and how will you meet them?

2. Have you ever been subject to disciplinary action at university, or arrested for anything other than a traffic violation? No____ Yes____ (please explain)

Applicant’s signature Date of application / /

Office of International Programs 36 University Place, Suite 350, Princeton University Princeton, New Jersey 08544