Fukuoka Resident Estimate Request

Note: This form is only for people who already live in Fukuoka, to request individual weekly lessons. If you do not live in Fukuoka, or want to study full-time, please fill out the intensive study form instead.

1. Contact Information

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

Home address 1
Home address 2
City
Prefecture	Fukuoka Prefecture

Telephone
Cell Phone
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

Enter the preferred number of 50-minute lessons per week.

Class Type

Lessons per week

	Group
	Private

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.