Meiji University Cool Japan Summer Program 2019 Application Form

(*) Required
After you submit the online application, an automatic reply will be sent to your e-mail address. Please change your email settings so you can receive emails from <>. If you do not receive the automatic reply, please contact us at <>.

Personal Information

Please fill out your name, date of birth, sex, nationality and passport expiration date exactly the same as in your passport.

Name (*)
Given (First)
Middle (if any)
Family (Last)
Date of Birth (*) / / (yyyy/mm/dd)
Sex (*) Male  Female
Nationality (*)
Main Language(s)
Current Address (*)
E-mail (*)
* Cool Japan Summer Program Team will contact you to this e-mail address.

Re-type e-mail address
Permanent Home Address (*) Same as above

Passport Expiration Date (*) / / (yyyy/mm/dd)

Current Academic Status

Country (*)
City (*)
University / Institution (the exact full name) (*)
School / College / Faculty (the exact full name) (*)
Major (*)
Degree Course (*) Undergraduate Master Doctor
Year / Grade (as of July 19, 2019) (*) First(freshman) Second(sophomore) Third(junior) Fourth(senior) Fifth Sixth Other
Entrance Date (*) / / (yyyy/mm/dd)
Expected Graduation Date (*) / / (yyyy/mm/dd)
Is your university / institution a partner institution of Meiji University? (*)
Your university / institution's official website (URL) (*)
A scanned copy or a photo of your student identification card or certificate of enrollment demonstrating that you will be enrolled on July 19, 2019. (*)
The maximum file size is 1MB. You can only upload PDF, JPG, JPEG, GIF and PNG files.
Information of your university / institution's international office or program coordinator
<When necessary, Meiji University will contact your university/institution directly.>
Affiliation / Office (*)
Title (*)
Name (*)
Phone (*)
E-mail (*)
Re-type e-mail address

Why do you want to participate in this program? (100-200 words) (*)

What theme/subjects of the program are you interested in the most? (100-200 words)

English Proficiency (for non-native English speakers)

Have you taken any of the tests below?
If yes, please enter the information below.
TOEFL Test Type:
Highest Score:
Date: / / (yyyy/mm/dd)
IELTS Highest Score:
Date: / / (yyyy/mm/dd)
(English tests only)
Test Name:
Highest Score:
Date: / / (yyyy/mm/dd)

About your participation

You must meet the following conditions in order to participate in the program.

I will attend ALL program activities from July 19 to July 30, 2019. (*) Yes
I will attend courses and give a presentation in English, and submit an assignment paper after the program. (*) Yes
I will purchase travel insurance (including health insurance) at my own expense to cover the whole period of my stay in Japan and submit a copy of my insurance certificate before arrival. (*) Yes
I understand that I am responsible for applying and obtaining a visa to Japan on my own expense, and that Meiji University will only provide assistance to students from Meiji University's partner institutions.(*) Yes
I understand the cancelation policy.(*) Yes

Accommodation Arrangement

Would you like to apply for the optional accommodation package? (Accommodation is not covered by the program fee, except for the one night during the Traditional Japan (Nikko) field trip.) The detailed information of the accommodation package will only be sent to those who have requested for one at this point, after their participation have been confirmed. (*) Yes
If “Yes”, please select your preference. First choice
Second choice
If "Yes", please agree to the following conditions.
I understand that the number of rooms is limited and Meiji University will make all decisions regarding accommodation and room assignments.
I agree

Emergency Contact

Please include the information of your parent/spouse or guardian.
Please ask your parent/spouse or guardian to change his/her email settings to so he/she can receive emails from <>.

Name (*)
Relationship (*)
Phone (*)
E-mail (*)
Re-type e-mail address

How did you learn of this program?

Meiji University Website  Facebook page  Instagram  Facebook ad  Instagram ad  Google search  Home university
Friend / acquaintance  Poster/brochure  Other

Past visits / stays in Japan (if any)

Place Period (from/to) Purpose

*Please read through the notice below.

  1. The program schedule may be subject to change.
  2. Meiji University reserves the right to cancel the program any time due to causes beyond its control (e.g. natural disasters).
  3. The program may be cancelled if the number of participants does not reach the minimum quota.
  4. Participants of the program are required to purchase overseas travel insurance (including health insurance) at their own expense to cover the period of their stay in Japan.
  5. Participants are responsible for applying and obtaining a visa to Japan on their own.
  6. Meiji University will only provide assistance in obtaining a visa to students from our partner institutions.
  7. Notification of acceptance with detailed information regarding the payment method of the program fee will be forwarded on March 7, 2019 <Japan Time> only to the successful applicants to the e-mail address registered on this application form. The payment deadline is March 21, 2019 <Japan Time>. Please be advised that your application will be void if payment of program fee is not settled by the deadline of March 21, 2019 <Japan Time>.
  8. If the number of participants does not reach the program quota, the second round of acceptance notifications will be sent out from March 25, 2019. For the additional acceptance notifications, please kindly understand that the payment deadline will be shorter (about a week).
  9. Cancelation policy will apply once payment is completed.
  10. The payment for the optional accommodation will be made directly to the travel agency and not to Meiji University.
  11. Meiji University reserve the right to make use of personal information provided in this application form in order to plan, implement and manage the program.

I verify that all information on this application is accurate.
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