Full Name

Please fill in your full name as shown in your passport.

Full name is required

Date of Birth

Please fill in your birth date as shown in your passport.

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Name of parent

Please fill in one of your parent name

Name of parent is required

Home Address

Please fill in your current home address in your country.

Home address is required

Which university at Hibikino Campus will you be attending? Kyushu Institute of Technology The University of Kitakyushu Waseda University IPS

Please select a university

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Email

Your email address will be used for future contact.

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Comments

Please let us know what we can do to assist you.

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