Please glue the
MAKUHARI INTERNATIONAL SCHOOL photograph of applicant
(SCHOOL YEAR 2010 - 2011) Approx. 4 cm x 5 cm
within 6 months.
(Please write the name
on the back.)
Last Name First Name Middle Name
ふりがな Date of Birth SEX
S (漢字） / / MALE
T Name in
Year Month Day FEMALE
N Application to
To join MIS in (Month) (Day)
N Visa Status
F (If Foreign National)
M Does he/she have siblings at Makuhari International School? Yes/No
A If so, please write the MIS student's name and class. (Name: Class: )
I Address in English
Address in Japanese (現住所 日本語でご記入ください）
（〒 － ）
TEL (home) FAX
E (in Japanese）
F (in English) Phone
M (in English) Phone
Current School he/she attends ( )
SCHOOL Language of Instruction ( )
Previous School Attended ( )
Language of Instruction ( )
Is English used at home?
Has your child studied in a full time International School before?
T ENGLISH ( )
U ABILITY How long has your child been speaking English?
D ( )
E Has your child had instruction in English additionally to time spent in school?
T ( )
Country Stayed ( )
F LIVING Period Stayed （ ／ ／ ～ ／ ／ ）
Year Month Day Year Month Day
T Does your child have any special learning needs?
I If so please provide information.
How long do you plan to stay at
Makuhari International School?
Who will be paying the tuition
Company Name ( )
If this is a company, please Person to be Contacted ( )
give details. Direct Phone Number of the Person ( )
Please explain how you found out
about the school.
QUESTIONS BELOW ARE FOR APPLICANTS TO KINDERGARTEN 1 ONLY
Can your child care for his/her
YES / NO
How often do you read stories to
What time does your child go to
Does your child take an
YES / NO *IF YES, HOW LONG? ( )
FOR ALL PARENTS - ANY ADDITIONAL INFORMATION YOU WOULD LIKE TO ADD? PLEASE WRITE BELOW.
Signed _____________________________________________________ Date___________________
All information disclosed in this form will be treated as confidential by the school and neither publicised to other third parties, nor
used for any other purposes.