Online Application for Local Students: Genki Japanese and Culture School

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Fukuoka Resident Estimate Request

Note: This form is only for people who already live in Fukuoka. If you do not live in Fukuoka, please fill out the non-resident form instead.
Please fill out all applicable fields, and click the Submit button.

1. Contact Information

Family name
First names
Sex	M F
Occupation
Birthdate
Nationality
Native language(s)

Home address 1
Home address 2
City
State/Prefecture

Telephone
Cell Phone
Fax
Email

2. Japanese Level

If you are not sure, check your level here.

Complete beginner
Beginner 1
Beginner 2
Pre-Intermediate
Intermediate
Advanced

Can you read hiragana/katakana?

Hiragana Katakana

How have you studied Japanese before? Please include textbooks used, school or university study, study in Japan at other language schools, and any Japanese exams passed (with scores, if available).

3. Course of Study

Check all the courses you would like to apply for, and enter the preferred number of 50-minute lessons per week. For more information about any of the courses, click the name, or visit the Course Information page.
Individual course packages can be created to match your needs. Please select the closest combination of classes and add a comment below. We will be happy to discuss your schedule with you in more detail.

Class Type

Lessons per week

Conversational Japanese
	Intensive	20/week
	Private
	Group

Japanese and Traditional Culture
	Intensive	20/week
	Group

Japanese through Pop Culture (must be Beginner 2 or above)
	Intensive	20/week
	Private
	Group
Japanese for Exams (only from September to November)
	Intensive	20/week
	Private
	Group

3.1 If you selected the Japanese Culture course above, please select your interests from the list below:

Japanese flower arrangement
Japanese tea ceremony
Calligraphy
Ceramics
Other art
Military arts
Religion/spirituality
Customs

Have you ever studied any Japanese culture; if so, what?

3.2 If you selected the Japanese Through Pop Culture course, please select your interests from the list below:

Manga/Anime
Movies
Music
Television

Have you read Japanese manga, watched movies, or listened to Japanese music before? Describe in as much detail as you can.

4. Other

Preferred start date
Number of weeks to study (if relevant)
I heard about GenkiJACS from
If "other", please specify:
If applying with another person, enter name(s) here:

Any further comments/questions?

I hereby state that I have read and understood the Terms and Conditions, and further state that the Terms and Conditions are to be incorporated as a part of any future contract.
(enter initials)

When we receive your application, we will send you a confirmation mail. You will have a chance to modify any of the information you have included in this form.