Your name in 漢字
a photograph
(passport size)
DO NOT WRITE ANYTHING HERE!!!!!
How to fill in your record card
Please note that I will not pass on personal information, such as your
e-mail address, to anyone else. You do not need to write down your e-mail
address if you do not want to. However, if I have this information, it
will make it easy for me to contact you.
Front
Your name in 漢字 |
a photograph (passport size) |
| Your name in ローマ字 |
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| Your student number |
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| Your e-mail address (optional) |
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DO NOT WRITE ANYTHING HERE!!!!! |
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Back
| 1. Have you ever lived in an English-speaking environment? Yes/No If you answered 'Yes', fill in a), b) and c) below. |
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| a) Where were you? (For example: New York, attending an American school; Indonesia, attending an international school; London, attending a Japanese school) | b)How old were you when you left Japan? | c)How long did you stay abroad? | ||||||
| 2. Where did you study English before coming to Keio? (Give the name of your high school and any juku etc.; if you had a 家庭教師, write "private tutor".) | ||||||||
| 3. Have you attended any other English classes in the Economics Faculty?
Yes/No If you answered 'Yes', fill in a), b) and c) below. |
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| a)Level |
b) Instructor |
c) Topic |
d) Grade (optional) |
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| 4. Your strong points in English (For example, are you good at reading English?) |
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| 5. Your weak points in English (For example, do you find it difficult to read English?) |
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| 6. Your goals in this course |
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| 7. Your interests/ambitions |
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