Online Registration for Incoming Exchange Students

This online registration is for the Student Exchange Program starting from Spring 2017 at Keio University. Applicants must be nominated by our partner institutions. You are also required to submit all the necessary application documents through your home institution.

FAMILY NAME
(in ENGLISH BLOCK CAPITALS)
* DO NOT use either characters with accent marks (e.g.  à, ç, ö) or Chinese characters.
* Spell your name as it appears on your passport.
GIVEN NAME
(in ENGLISH BLOCK CAPITALS)
* DO NOT use either characters with accent marks (e.g.  à, ç, ö) or Chinese characters.
* Spell your name as it appears on your passport.
MIDDLE NAME(s)
(in ENGLISH BLOCK CAPITALS)
* DO NOT use either characters with accent marks (e.g.  à, ç, ö) or Chinese characters.
* Spell your name as it appears on your passport.
FAMILY NAME in KATAKANA
(if possible)
GIVEN NAME in KATAKANA
(if possible)
MIDDLE NAME in KATAKANA
(if possible)
FAMILY NAME in Chinese Characters
(If possible)
* Some Chinese characters may be registered in Katakana if our system is unable to input.
GIVEN NAME in Chinese Characters
(If possible)
* Some Chinese characters may be registered in Katakana if our system is unable to input.
MIDDLE NAME in Chinese Characters
(If possible)
* Some Chinese characters may be registered in Katakana if our system is unable to input.
Nationality  
Gender Male　　 Female
Date of Birth   (yyyy/mm/dd) e.g.) 1994/01/21
Country of your home institution
Name of your home institution

For students from University of California
Name of Campus        
Faculty/Department
Major
Minor
Period of intended study at Keio One semester (2017 Spring Semester: Apr. 2017 - Jul. 2017)
Two semesters (2017 Spring & 2017 Fall Semester: Apr. 2017 - Feb. 2018)
Program at Keio Keio International Program (KIP)

Japanese Language Program (JLP)
Research Program  (for graduate students only)
Present Contact:
Address Apartment/Street
Town/City
Province/State
Postal Code
Country
Phone Number   e.g.) (+81) 3-5427-1798
                                                   please put country code in (+ )
Mobile   e.g.) (+81) 3-5427-1798
                                                   please put country code in (+ )
E-mail Address 　
e.g.) taro.keio@keio.ac.jp
Confirm E-mail Address 　
e.g.) taro.keio@keio.ac.jp
Permanent Contact:
Address Apartment/Street
Town/City
Province/ State
Postal Code
Country
Phone Number   e.g.) (+81) 3-5427-1798
                                                   please put country code in (+ )
Note

We would like to have your consent to handle your personal information for our exchange program. We are planning to include your personal information (name, student ID, home institution and e-mail address) on lists of students we distribute to all incoming students and also to Keio students who will go on exchange in both this year and next.

We believe these lists should be useful for gathering information and for networking during and after your exchange period. If you, however, wish NOT to be included on these lists, please tick “no”.

YesNo

 Personal information provided by you will be used by Keio University for the administration of the 2017 Spring Semester Exchange Program. Keio University will use your personal information appropriately and will take measures to protect and ensure the security of this information in accordance with its Privacy policy. 
Keio University may disclose your personal information to necessary outside parties involved the administration 2017 Spring Semester Exchange Program.