SIU at Niigata Online Application

 
  1. Legal Name:

    2. Title
    Last:  First:
  2. Permanent Home Address: 

    3. Street 
    City 
    State / Prefecture
    Postal Code:  Country:  
  3. Phone No: 
  4. Address to which correspondence should be sent if different from above:

    5. Street 
    City 
    State / Prefecture
    Postal Code:  Country:  
  5. Birth date (use numbers only): Month: Day:  Year: 
  6. Sex: 
  7. Intended major: (if you don't know yet, please enter "undecided".) 
  8. Term for which you are applying:  Year 
  9. Name of high school from which you graduated:
    Dates of attendance:  from Month:  Year:  to Month:  Year: 
    Graduation Date: Month:  Year: 
    High School Address: 
    Street   
    City   
    State / Prefecture 

    10. Postal Code: 

  10. List ALL colleges/universities you have attended:

    11. College / University:  
    City / State / and Country:   
    Dates of Attendance:   
    Certificates / Degrees / Diplomas Earned: 
    College / University:  
    City / State / and Country:   
    Dates of Attendance:   
    Certificates / Degrees / Diplomas Earned: 
  11. How do you evaluate your English ability? 

    12. Reading:  Writing: 

    Listening:  Speaking: 

    Click here to return to the main page.

    Note: If you are an American student who wishes to apply for the International Studies in Japan Program, see the SIUC Study Abroad website.

   
Copyright © 2002, Southern Illinois University at Carbondale in Niigata
Last Updated: August 29, 2002
This page is maintained by Adam Coulter