University of Leicester  
Japan Agent
Preliminary Enquiry Form
Name(Japanese) :
Name(English) :
    TEL :
SEX(Male or Female) :
E-MAIL (PC only) :
Date of birth (year, month, day) :
Zip Code :
Address(Japanese) :
Address(English) :
Which University / college / School 
have you attended?
(in Japanese)
* Which year are you in (if applicable) : 年生
Subjects studied and results obtained?
(your Major and Degree)
English Language Test Score?(if applicable) :
What subject or course do you want to take at
Which course  
Undergraduate (Campas/Distance Learning)? (eg. BA, BSc) 
Postgraduate(Campus/Distance Learning)? (e.g. MA, Msc) 
Doctoral Research? (e.g. MPhil, PhD) 
Study Abroad Programme?
(e.g. English Pe-sessional/International Summer Programmes/English for Medics International Programme)
Foundation Programme?
Year you would like to Enter  :
Need information on the
English Language Programmes?
How do you get to this homepage? :
Please describe your questions in Japanese :