Aikido Mugenjuku Kenshusei Course Application Form
Name
*
First Name
Middle Name
Last Name
Name in Katakana if known
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Emergency contact name
*
First Name
Last Name
Emergency contact phone number
*
-
Current dojo name and location
Instructor's name
First Name
Last Name
Date began Aikido
-
Month
-
Day
Year
Date
Current Rank
No kyu
6th kyu
5th kyu
4th kyu
3rd kyu
2nd kyu
1st kyu
Sho dan
Ni dan
San dan
Yon dan
Go dan
Roku dan
Are you already living in Japan?
*
Yes
No
Visa Status / Type
Visa Expiration Date
-
Month
-
Day
Year
Date
Employer
Potential work conflicts
If not living in Japan, when is your expected arrival date?
-
Month
-
Day
Year
Date
Do you plan to work during the course?
Yes
No
If not, how will you support yourself?
Please Tell us why you want to do the Kenshusei Course and what you hope to achieve.
*
Please attach a letter of recommendation from either a teacher, business associate, friend, or family member.
*
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