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Trial Japanese Lesson Request Form
To offer a trial lesson tailored to your specific needs, we require the following information. If you do not want to submit the request via Internet simply print this page and Fax it to: 03-6368-5461.
We are sorry but Tokyo area only
.
Name First Family
Nationality
Address
Pref
City
Address
Telephone
Fax
Mobile
Occupation
E-Mail
Date of Birth
Gender Male Female
Native Laguage
When did you arrive in Japan most recently?
Have you studied Japanese? No Yes (if yes, please fill in in the following.)
Length Text books used Lesson style
Private Semi Private Group
Private Semi Private Group
Private Semi Private Group
With whom do (would) you speak Japanese?
Superiors co-workers customers family members friends other
How many hiragana can you read? None more than 10 more than 30 all
How many katakana can you read? None more than 10 more than 30 all
How many kanji can you read? None more than 10 more than 100 more than 300
What is your main prupose for studying Japanese?
Which skills do you want to improve in this course? (multiple checks OK)
Speaking Listening Reading Writing
When would you like your trial lesson?
Select your most prefered date Date
:
Select an alternate date Date
:
Where would you like your trial lesson to take place? Workplace Home
Address
Closest Station   Line    
Station    
How long do you intend to study Japanese?
Others/Comments