Application for Caregiver Nihongo Class

Items marked with 「*」must be filled otherwise your application form will be error.

Input Procedure:

1) Complete this form
2) Click button of 内容確認(confirmation of input contents)
3) Click button of 送信(send)
4) Click button of 終了(end)

Please note that we will contact you later basically via Facebook messenger, so please request friend to Mr. Bunji Inoue at if you are not his friend yet. Being a FB friend of Mr.Bunji Inoue is one of the requirements for
the admission.

Nihongo Name *
Please re-write your name with kanji, hiragana and katakana.
Name in ローマ字 *
I hereby apply for caregiver nihongo clas and agree to the privacy policy in .
First Name -> Family Name -> Middle Name
Write your FB Name *
Please note that you will have to be FB friend of Mr.Bunji Inoue. He will send you message by messenger.
Birthday *
Age *
Sex *

Your nationality? *
Address *
Zip Code *
Phone Number *
E-mail Address *
Please input 2 times your email address.

How long in Japan? *
How many years have you been in Japan?
Nihongo Level? *
ひらがな、カタカナ、かんじを どのくらい よんだり、かいたり できますか?
Caregiver License *

Are you a caregiver? *

Any Message to Us?