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) :
IELTS
TOEIC
TOEFL
Others
What subject or course do you want to take at
Leicester? 		:
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?		 :
Yes
How do you get to this homepage? :
Please describe your questions in Japanese :
   
     
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