Application for Kaigofukushishi Lesson

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 and our service.

You can also apply for kaigofukushishi online lesson with this form. Online lesson tuition fee is 2,000 yen per month (Registration fee is also 2,000 yen and the monthly tuition is charged from the following month of registration.).

*Please kindly note that the payment due date of online lesson and もぎしけん(mock exam) will be 1 week from your application.

Name in Alphabet *
I hereby apply for kaigofukushishi class lesson and agree to the privacy policy in .
First Name -> Family Name -> Middle Name
なまえ(にほんご) *
Please input your name in Japanese hiragana, katakana or kanji.
Write your FB Account Name *
Please note that you will have to become FB friend of Mr.Bunji Inoue. He will send you message by messenger. So, check your messenger later.
Birthday *
Age *
Sex *

Address in Japanese *
Please write your address in Japanese if possible.
Zip Code *
Phone Number *
CP number is better.
E-mail Address *
Please input 2 times your email address.

Caregiver License *
Which license do you have now?

Work Experience as a caregiver *
Where and How long?
Which lesson? *
Select your course below. Selection of Online Lesson is mandatory for application for Year 2019 class lesson. In this case, please write which month you want to start this online lesson in the next message box.

Any Message to Us?
Nationality *
Are you EPA? *