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Fields marked with ※ are required.
See our privacy policy page for details about how we handle your personal information.

Candidate Information

First Name ※
Middle Name
Last Name ※
Gender ※	Male Female
Date of Birth ※	-- 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 / -- 1 2 3 4 5 6 7 8 9 10 11 12 / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Nationality ※
Additional Nationality
Year Applying ※	2023-2024 2024-2025
Grade Applying ※	Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Candidate lives with (Both parents, Mother, Father, Other) ※
Expected length of study at JINIS ※
How did you hear about JINIS? ※	Website Magazine or Newspaper Google Search Friends Institution or Agent Other

Educational Background

Is the candidate presently in school or kindergarten? ※	Yes No
Name current school or kindergarten
Has the candidate ever repeated or skipped a grade? ※	Yes No
If yes, which grade and for what reason?
Has the candidate ever been dismissed? ※	Yes No
If yes, when and for what reason?
Has the candidate ever been diagnosed with a learning difference? (e.g. dyslexia, dysgraphia, dyscalculia dyspraxia, or ADHD) ※	Yes No If yes, please submit copies of any psycho-educational evaluations and individualized education plans the student has received to the admissions office via email.
Has the candidate ever received learning support and or/ tutoring? ※	Yes No
If yes, which subjects and for how long?
It is our primary concern that pupil is happy, healthy and safe at JINIS. Is there anything we need to know about your child’s physical or mental healthy, dietary issues, or other personal needs?
If yes, please write this further below, and make us aware of information about diagnoses, follow-up care, psychoeducational evaluations, or any other documents that will help us better understand your child.

Language Communication

Has your child studied in English? ※	Yes No
Has your child studied in Japanese? ※	Yes No

Household Information

Parent/Guardian 1 ※	First Name Last Name
Relation to candidate (Father, Mother, Legal Guardian, Other) ※
Preferred Language ※	English Japanese
Mobile phone number (Include country code) ※
Email address ※
Confirm contact email address ※
Address ※	First Street City State/ Province Postal Country
Place of employment
Parent/Guardian 2	First Name Last Name
Relation to candidate (Father, Mother, Legal Guardian, Other)
Preferred Language	English Japanese
Mobile phone number (Include country code)
Email address
Confirm contact email address
Address	First Street City State/ Province Postal Country
Place of employment

Siblings

Sibling 1 Full Name
Date of Birth	> -- 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 / > -- 1 2 3 4 5 6 7 8 9 10 11 12 / > -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Sibling 2 Full Name
Date of Birth	-- 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 / -- 1 2 3 4 5 6 7 8 9 10 11 12 / -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Related Contact

Please fill below who are authorized to pick up the candidate, need to receive school-related information.

Name	First Name Last Name
Relation to Candidate (Grandparent, Aunt/Uncle, Nanny/Caretaker, Agent, Other )
Mobile phone number (Include country code)
Email address
Confirm contact email address
Address	First Street City State/ Province Postal Country
Emergency Contact ※	Parent 1 Parent 2 Related Contact
Financial Sponsor ※	Parent 1 Parent 2 Related Contact

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