Application Form - APU Ritsumeikan Asia Pacific University

APU Academic and Cultural Experience (ACE) Programme 2015
This application form is for those who are applying to the December ACE
camp
Application Documents
All of the following documents must be submitted to APU Admissions Office (International) by the application
deadline: Friday, September 18, 2015(Date of Postmarked)
1. APU Academic and Cultural Experience (ACE) Programme Application Form
2. Signed Pledge (p.5 - p.7)
3. Copy of Passport (photo page)
Your passport must have at least six months of validity remaining starting from the day you enter Japan.
For those who do not yet possess a passport, please apply for one as soon as possible. Once your passport has
been issued, please send a copy to APU by post or email.
4. One passport-sized photograph (4cm X 3cm)
5. Certificate of Enrollment at current school
Please use your school’s official form and get it signed by the school’s principal and/ or stamped with an official
school seal.
An official signed and dated translation must also be included for any documents that are submitted in a language
other than English.
Application Submission
Submit all the application documents to:
1-1 Jumonjibaru, Beppu, Oita 874-8577 JAPAN
Ritsumeikan Asia Pacific University
Admissions Office (International)
“APU ACE 2015 Programme”
Tel:+81-977-78-1119
DECEMBER
APU Academic and Cultural Experience (ACE) Programme 2015
1. Applicant Information
1. Given Name:
Please affix a photograph
2. Family Name:
(4cm X 3cm),
3. Date of Birth:
□
4. Gender:
Year
Male
Month
Date
taken within the last 3 months.
□
Female
5. Nationality:
6. Email:
7. Current Address:
City / State
Phone:
Country Code (
Country
)
Postal Code
Mobile:
Country Code (
)
8. Current School Name:
9. Current School Address:
City / State
Country
Postal Code
10. Emergency Contact:
Person:
Relationship to you:
Address:
City / State
Phone: Country Code (
Country
)
Postal Code
Mobile: Country Code (
)
2. Language Proficiency
1. Native Language:
2. Language taught at current school
3. Language Proficiency:
①Language:
Level: （Native・Fluent・Intermediate・Beginner）
Test / Qualifications results (E.g. TOEFL®iBT score)
①Language:
Level: （Native・Fluent・Intermediate・Beginner）
Test / Qualifications results (E.g. TOEFL®iBT score)
2
DECEMBER
3. Education History
1. What is your current grade in school?
Grade:
2. Please list all schools that you have attended from elementary school level to the last or current school you are attending.
□Name of school:
City / State
Status(E.g; Graduated):
Duration:
□Name of school:
City / State
Status(E.g; Graduated):
Duration:
□Name of school:
City / State
Status(E.g; Graduated):
Duration:
□Name of school:
City / State
Status(E.g; Graduated):
Duration:
Country
years
Country
years
Country
years
Country
years
4. Additional Information
1. Do you have any food allergies and/ or dietary restrictions?
* Any concerns addressed here will not affect admission decisions.
* All successful applicants will be asked to submit a Special Needs form and a Medical Consent form signed by the school health center
or a physician. These forms will be sent along with the acceptance package.
2. Do you need to apply for a visa to enter Japan?
□ Yes
□ No
* Please check with the Japanese Embassy in your country beforehand about the application requirements for the right procedures.
3
DECEMBER
Application Essay (Name:
)
1. Please write the reasons why you wish to participate in the APU Academic and Cultural Experience
Programme 2015 in English.
2. Please write about some extra-curricular activities you have done in recent years.
4
DECEMBER
Terms
I hereby apply for admission to the "APU Academic and Cultural Experience (ACE) Programme 2015"
(Hereinafter referred to as "the programme") according to the following terms:
1. The application documents shall not contain any falsified information.
2. The programme fee includes the costs for the followings:
Round-trip transportation between Fukuoka International Airport/ Oita Airport and APU
Travel within Japan over the duration of the programme
Accommodation costs during the programme
3 meals/ day (From lunch on December 13 to breakfast on December 20)
Activity fee
Home stay fee (food included)
Oversea Travel Insurance for applicants living outside Japan
Domestic Comprehensive Travel Insurance for applicants living in Japan
I must pay any additional expenses that are not included in the programme fee. I must pay the programme
fee to the bank account specified by Ritsumeikan Asia Pacific University by the designated deadline.
3. If I withdraw from the programme for my own reasons, a refund will be provided according to the following
terms.
Cancellation Policy:
APU will refund 50% of the programme fee plus the total cost of the insurance premium in the case of
cancellation provided the applicant contacts the university (either by telephone or email) by October 30,
2015. No refunds will be provided after this date under any circumstances.
In cases where unusual and unforeseen circumstances arise due to reasons beyond our control, including
but not limited to natural disasters, acts of war, civil commotion, suspension and/or closure of Tour
Services such as transport and accommodation facilities, exercises and/or orders from government and
other public agencies, and other such circumstances that affect the safe and smooth implementation of
this tour, APU reserves the right to cancel the entire programme. In this instance, APU will refund the full
amount of the programme fee to the applicants.
4. I am liable for any debt incurred while in Japan.
5. I will not hold Ritsumeikan Asia Pacific University responsible, monetarily or otherwise, should I cause an
accident or become ill by my own negligence or in circumstances that are out of Ritsumeikan Asia Pacific
University’s control.
6. I will bear sole responsibility for dealing with matters such as theft or damage of my personal items, traffic
accidents, criminal cases, or other matters that may arise that are outside of Ritsumeikan Asia Pacific
University’s control.
7. If I cause any serious damage to Ritsumeikan Asia Pacific University, deliberately or by gross negligence, I
am liable to compensate for the damages.
8. If I should violate any of the matters in the Pledge, Ritsumeikan Asia Pacific University may direct me to
withdraw from the programme or return to my home country.
5
DECEMBER
Personal Information Policy
Personal information collected from individuals during the programme application process and commencement
will be handled in accordance with the following:
(1) Purpose of Use of Personal Information
a. To carry out the application process, such as screening, etc.
b. To notify results
c. To send programme-related documents
d. To send various questionnaires or university information after the programme
e. To arrange accommodation in AP House/homestay
f. To organize programme activities
g. To sign up for domestic/overseas accidental insurance
h. Programme promotion
i. Emergency contact
(2) Management of Personal Information
Ritsumeikan Asia Pacific University will manage the personal information of application in compliance with
relevant laws and regulations. Information will be managed securely to prevent loss, destruction or divulgence.
(3) Statistical Use of Personal Information
Ritsumeikan Asia Pacific University may use data extracted from applicants’ personal information to conduct
various statistical analysis to be used for surveys and research relating to the programme. This data may also
be provided to students interested in applying to the future programmes at Ritsumaikan Asia Pacific University.
However, the university shall ensure that any information made public cannot be used to identify specific
individuals.
6
DECEMBER
Pledge
As a participant of the "APU Academic and Cultural Experience (ACE) Programme 2015" (hereinafter
referred to as "Programme"), I hereby pledge that:
1. I understand the outline and aim of the Programme and I will attend all scheduled classes and activities.
2. For the duration of the Programme, I will conduct myself with the awareness that I am a Programme
participant.
3. For the duration of the Programme, I will follow the instructions given to me by the Ritsumeikan Asia
Pacific University staffs and the Programme coordinators and will not violate any public policy, law, or
regulation of Japan.
4. I will abide by the rules and regulations of the residential facility.
5. Staying healthy for the duration of the Programme will be my own responsibility, and if I am injured or
become ill during the Programme period I am responsible for undergoing any medical treatment that may be
required.
6. I will not operate or purchase a bicycle, car, motorbike, or any other vehicle.
Declaration
and
Signature
for
Application
Documents,
Terms,
Personal
Information Policy, and Pledge
I understand that the University may vary or cancel any decision if any incorrect or incomplete information is
given; submitted documents for this application become the property of the University and will not be returned
to me.
I hereby declare that all information provided are true and correct.
Applicant’s Signature
Date
For Parent / Legal Guardian
As my child’s, identified above, parent / legal guardian, I support my child’s decision to participate in the
programme. By signing below, indicate that I have reviewed the above pledge and the following terms with my
child and that we understand and agree to the above pledge and the following terms presented by APU. I also
declare that the signature inscribed below is my signature.
Name
Date
Signature
7
DECEMBER
2015.3