Self-introduction form

Please note that we will not be able to arrange a homestay or shared apartment for you if you do not send us this information.

Name / 氏名*

First NameMiddle NameLast Name

Name in Japanese (katakana) / カタカナの名前

If you know

E-mail address / メールアドレス*

e.g. example@example.com

Which school will you attend? (If you are studying at multiple locations, what is the first school you will study at?) / 通う予定の学校*

FukuokaTokyoKyotoNagoya

Which school will you attend? (If you are studying at multiple locations, select all schools you will study at.) / 通う予定の学校*

FukuokaTokyoKyotoNagoya

Date of birth / 生年月日*

YearMonthDay

If you are below the age of 20, you are prohibited by Japanese law from smoking or drinking. Please note that being caught doing either of these will result in disciplinary action.

Nationality / 国籍*

Native language(s) / 母国語*

Will you come to Japan with a long-term visa such as a student visa or working holiday visa? / 長期滞在ビザですか？*

YesNo, I will stay in Japan as a touristOther

Gender / 性別*

MaleFemaleOther

I am over 100kg in weight / 体重100kg以上*

YesNo

Exact weight / 体重

Only if you don't mind telling us

I am over 190cm in height / 身長190cm以上*

YesNo

Exact Height / 身長

Only if you don't mind telling us

Japanese beds are typically smaller than Western beds. If you fit one of the above descriptions, we will make special arrangements for you.

Occupation / 職業

Home address / 住所

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone number / 電話番号

Country CodeArea CodePhone Number

Emergency contact name / 緊急連絡先氏名*

First NameLast Name

Emergency phone number / 緊急連絡先電話番号*

Country CodeArea CodePhone Number

How well can you speak English? / 英語力

	1	2	3	4	5

1 is Just a little, 5 is Fluent

How well can you speak Japanese? / 日本語力

	1	2	3	4	5

1 is Just a little, 5 is Fluent

How well can you read Japanese? / 日本語の読解

	1	2	3	4	5

1 is I can't, 5 is I can read well

Do you speak any other languages? / 他に話せる言語

How many hours have you studied Japanese?

How many times have you been to Japan?

How many times have you been to Japan? / 来日回数

Have you ever done a homestay before? / ホームステイ経験

YesNo

Where was your homestay, and how long was it? / ホームステイ経験詳細

Are you comfortable with a family that has a young child/children (aged 3 to 6)? / 3歳～6歳の子どものいる家庭でもいいですか*

YesYes, but would rather avoid if possibleNo

Are you comfortable with a family that has a baby/babies (3 years old or less)? / 3歳以下の子どもがいる家庭でもいいですか*

Yesyes, but would rather avoid if possibleNo

Would you be comfortable being placed with a single mother living alone? / ホストマザー一人暮らしの家庭でもいいですか*

YesYes but would rather avoid if possibleNo

Would you be comfortable in a family that also hosts other guests/students? / 他のゲストがいる家庭でもいいですか*

YesYes but would rather avoid if possibleNo

Any pets you don’t like?*

The more strict your preferences, the further away from school the family may be.

In Kyoto, all families generally host more than one guest. Requesting to be the only guest means you will be placed in neighboring cities (likely Osaka) with a long commute.

Are there pets you wish to avoid? / 苦手なペットはいますか*

NoOther

Do you smoke? / 喫煙しますか*

YesNo

Is it OK if a member of the family smokes ? / 喫煙するファミリーでもいいですか*

Yes, I don't mindYes, I don't mind if they smoke outsideNo, I'd rather avoid such a family

Do you have any food or drink restrictions, and for what reason? / 食事制限はありますか*

Which of these do you -NOT- eat/drink? 食べられない食材*

Other: List foods you do NOT eat other than those listed above. Also, describe your situation like the example below. / その他の食べられない食材とその詳細*

e.g. OK in small quantities or in soup/stock preparation, but dislike overall

Which kind of meat do you -NOT- eat? 食べられないお肉の種類*

Which of these would you -NOT- eat?

Food with very small amounts of meat (e.g. salad with bacon bits on top)Food that was prepared with meat, but has had the meat taken out (e.g. chicken curry with the chicken pieces removed).Food containing small amounts of animal extracts (e.g. fish oils, animal fats)Food containing small amounts of dairy products (e.g. butter)Food that was prepared in the same cooking area as meatOther

Details for Meat*