Self-introduction form

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*
Please enter an email address where you (the applicant) can be reached directly.
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*

FukuokaTokyoKyotoOkinawaNagoya
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 (aged 0 to 2)? / 2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*

No restrictionAllergiesMedical reasonsReligious reasonsvegan / vegetarian / other dietsDislikeOther
Do you have any food or drink restrictions, and for what reason? / 食事制限はありますか*

No restrictionsYes, I have
If any dietary restrictions are discovered after you have moved into your homestay, there is a risk of accidental consumption or difficulties for your host family in accommodating your needs.
To ensure a safe and comfortable stay, please make sure to accurately declare any dietary restrictions in advance.
Important Note:
To ensure accurate documentation of your dietary restrictions, please select the appropriate main category first (e.g., Meat, Fish, Eggs, Dairy). You will then be able to specify the details within that category in the next step.

Example:
If you cannot eat beef, please first select "Meat" and then choose "Beef" in the following step.

Please use the "Other" field only if your restriction does not fit into any of the provided categories (e.g., allergies to specific additives or other special dietary needs).
Which of these do you -NOT- eat/drink? 食べられない食材*

MeatSeafoodFishEggsMilk / DairyAlcoholNutsFlourOther than this list
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*

Any meatBeefPorkChickenLamb / MuttonOther
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*

The meat itself cannot be eaten, but byproducts (extracts, etc.) are allowedCannot be eaten if it includes any part of the meat (extracts, etc.)Other
What is the reason you do not eat the meat?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Beef*

The meat itself cannot be eaten, but byproducts (extracts, etc.) are allowedCannot be eaten if it includes any part of the meat (extracts, etc.)Other
What is the reason you do not eat Beef?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Pork*

The meat itself cannot be eaten, but byproducts (extracts, etc.) are allowedCannot be eaten if it includes any part of the meat (extracts, etc.)Other
What is the reason you do not eat Pork?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Chicken*

The meat itself cannot be eaten, but byproducts (extracts, etc.) are allowedCannot be eaten if it includes any part of the meat (extracts, etc.)Other
What is the reason you do not eat Chicken?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Lamb / Mutton*

The meat itself cannot be eaten, but byproducts (extracts, etc.) are allowedCannot be eaten if it includes any part of the meat (extracts, etc.)Other
What is the reason you do not eat Lamb / Mutton?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Other (Meat)*

The meat itself cannot be eaten, but byproducts (extracts, etc.) are allowedCannot be eaten if it includes any part of the meat (extracts, etc.)Other
What is the reason you do not eat the meat?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Which kind of seafood do you -NOT- eat? 食べられないシーフードの種類*

Any seafoodShrimpSquidOctopusShellfish/ClamOther
Details for Seafood*

Cannot be eaten raw, but okay if cookedCannot be eaten regardless of the cooking method, but byproducts (soup stock, extract, etc.) are allowedCannot be eaten if it includes any seafood (extracts, soup stock, etc.)Other
What is the reason you do not eat the Seafood?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Shrimp*

Cannot be eaten raw, but okay if cookedCannot be eaten regardless of the cooking method, but byproducts (soup stock, extract, etc.) are allowedCannot be eaten if it includes any seafood (extracts, soup stock, etc.)Other
What is the reason you do not eat the Shrimp?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Squid*

Cannot be eaten raw, but okay if cookedCannot be eaten regardless of the cooking method, but byproducts (soup stock, extract, etc.) are allowedCannot be eaten if it includes any seafood (extracts, soup stock, etc.)Other
What is the reason you do not eat the Squid?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Octopus*

Cannot be eaten raw, but okay if cookedCannot be eaten regardless of the cooking method, but byproducts (soup stock, extract, etc.) are allowedCannot be eaten if it includes any seafood (extracts, soup stock, etc.)Other
What is the reason you do not eat the Octopus?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Shellfish/Clam*

Cannot be eaten raw, but okay if cookedCannot be eaten regardless of the cooking method, but byproducts (soup stock, extract, etc.) are allowedCannot be eaten if it includes any seafood (extracts, soup stock, etc.)Other
What is the reason you do not eat the Shellfish/Clam?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Other (Seafood)*

Cannot be eaten raw, but okay if cookedCannot be eaten regardless of the cooking method, but byproducts (soup stock, extract, etc.) are allowedCannot be eaten if it includes any seafood (extracts, soup stock, etc.)Other
What is the reason you do not eat the Seafood?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Fish*

Cannot be eaten raw, but okay if cookedCannot be eaten regardless of the cooking method, but byproducts (soup stock, extract, etc.) are allowedCannot be eaten if it includes any fish (extracts, soup stock, etc.)Other
What is the reason you do not eat the Fish?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Eggs*

Cannot be eaten raw, but okay if cookedCannot be eaten even if cooked, but byproducts are allowedCannot be eaten if it includes any egg products (mayonaise, etc.)Other
What is the reason you do not eat the Eggs?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Milk/Dairy*

Cannot be eaten raw, but okay if cookedMilk itself is not allowed (even if cooked/heated), but dairy products such as butter, cheese and yogurt are allowedCannot eat dairy products such as butter and cheese, but byproducts are allowedCannot eat foods that include any kind of dairy such as panko bread crumbs, stews or curry rouxOther
What is the reason you do not consume the Milk/Dairy?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Alcohol*

Cannot drink alcohol by itself, but food with raw materials/seasonings are allowed (cooking alcohol, mirin, etc.)Cannot consume anything with any kind of alcohol (including ingredients, seasonings)Other
What is the reason you do not consume the Alcohol?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Which kind of nuts do you -NOT- eat? 食べられないナッツの種類*

Any nutsWalnutsPecansCashewsAlmondsPistachiosHazelnutsOther
Details for Nuts*

Cannot eat nuts by themselves, but byproducts are allowedCannot eat anything with nuts and/or nut byproductsOther
What is the reason you do not eat the Nuts?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Walnuts*

Cannot eat nuts by themselves, but byproducts are allowedCannot eat anything with nuts and/or nut byproductsOther
What is the reason you do not eat the Walnuts?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Pecans*

Cannot eat nuts by themselves, but byproducts are allowedCannot eat anything with nuts and/or nut byproductsOther
What is the reason you do not eat the Pecans?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Cashews*

Cannot eat nuts by themselves, but byproducts are allowedCannot eat anything with nuts and/or nut byproductsOther
What is the reason you do not eat the Cashews?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Almonds*

Cannot eat nuts by themselves, but byproducts are allowedCannot eat anything with nuts and/or nut byproductsOther
What is the reason you do not eat the Almonds?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Pistachios*

Cannot eat nuts by themselves, but byproducts are allowedCannot eat anything with nuts and/or nut byproductsOther
What is the reason you do not eat the Pistachios?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Hazelnuts*

Cannot eat nuts by themselves, but byproducts are allowedCannot eat anything with nuts and/or nut byproductsOther
What is the reason you do not eat the Hazelnuts?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Other (Nuts)*

Cannot eat nuts by themselves, but byproducts are allowedCannot eat anything with nuts and/or nut byproductsOther
What is the reason you do not eat the Nuts?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
Details for Flour*

Cannot eat bread or noodles, but small amounts of wheat products such as fried food or tempura is okayCannot eat food with even small amounts of wheat (fried food, tempura, etc.) but food made with wheat byproduct are okayCannot eat foods that include any kind of wheat such as sauces, stews or curry rouxOther
What is the reason you do not eat the Flour?*

AllergiesMedical reasonsReligious reasonsVegan/ Vegetarian/ Other personal dietary choicesDislikeOther
List foods or drinks you cannot consume at all, even in small quantities / 口にできない食材*
List foods or drinks forbidden by your diet and describe how strict it is / 口にできない食材*
List foods or drinks you cannot consume because of your religion / 宗教上口にできない食材*
e.g. Alcohol, pork, meat and dairy together...
List your food or drink allergies / アレルギーのある食材*
e.g. Wheat allergy, lactose intolerant...
What kinds of meals you usually eat for breakfast, including specific foods / 普段食べている朝食*
eg. toast, fried eggs, corn soup, salad, pasta, curry, etc
What kinds of meals you usually eat for dinner, including specific foods / 普段食べている夕食*
eg. toast, fried eggs, corn soup, salad, pasta, curry, etc
Describe the symptoms of your food allergies, and how to manage them / アレルギーの症状とその対処法*
What medicine do you use? / 服用している薬*
If you have any notes about meals other than avobe, please list them here. / その他、食事制限に関するコメント
Do you have any medical conditions, allergies, or disabilities diagnosed by a medical professional? / 診断された病状、アレルギー、障害はありますか*

NoPhysical disabilitiesMental disorders (e.g. ADHD, depression, autism...)Allergies (e.g. pets, medication, insects, house dust...)
Could you please specify the name(s) of the diagnosed physical disabilities? / 診断された病名（身体的な症状）*
Describe your condition for the physical disabilities in as much detail as possible / 症状の詳細（身体的な症状）*
Include the symptoms, treatment, frequency of occurrences...
List any medicine you use for the physical disabilities / 服用している薬（身体的な症状）*
Could you please specify the name(s) of the diagnosed mental disabilities? / 診断された病名（精神的な症状）*
ADHD, depression, autism...
Describe your condition for the mental disabilities in as much detail as possible / 症状の詳細（精神的な症状）*
Include the symptoms, treatment, frequency of occurrences...
List any medicine you use for the mental disabilities / 服用している薬（精神的な症状）*
Could you specify the name(s) of any allergies you have? / 診断された病名（アレルギー）*
pets, medication, insects, house dust
Describe your condition for the allergies in as much detail as possible / 症状の詳細（アレルギー）*
Include the symptoms, treatment, frequency of occurrences...
List any medicine you use for the allergies / 服用している薬（アレルギー）*
Is your condition entirely self-manageable? / 自分で対応可能ですか*

Yes, there is no scenario where I'd need external help or assistanceNo
Describe your condition in as much detail as possible / 症状の詳細*
Include the symptoms, treatment, frequency of occurrences...
List any medicine you use / 服用している薬*
Will you need any special support or infrastructure at school or at your accommodation? / 学校や滞在先で特別なサポートは必要ですか*

YesNo
Please tell us what kind of support you'd like to receive / 必要なサポートの詳細*
Is there anything about you or your lifestyle you would like your family to know? / 事前にホストファミリーに伝えておきたいこと
Timid, religious, anxious, night owl...
Is there anything that you would particularly like to do while in Japan? / 日本に来てしたいこと
What do you like to do? (Hobbies, how you spend your free time, etc) / 趣味
Is there any other important information for your host family to know (religion, personal habits, etc.) ?

ReligionHabitsOther
Please give us more details about the options you selected above:
If you have any special requests for your host family, please list them here. We’ll try our best to accommodate your request, but we can’t guarantee it.
Please write any specific requests you may have for your family / ホストファミリーへの特別なリクエスト
e.g. Music lovers, pet owners...
Please write a short letter to your host family (in English or Japanese) / ホストファミリーへの手紙*
Please upload a profile photo so that we can see what you look like*

Upload a File
Any photo where your face is visible is fine Cancelof
*

I understand that if I am under the age of 20, it is illegal for me to smoke or drink alcohol in Japan and if I am caught doing either of these, I may be asked to leave the school.
Should be Empty: