Application Form

Japanese Language Beginners Course Summer 2011

* Please submit this Application Form to secretariat@soi.asia until July 14th(Thu), 2011. And in the subject/title, please write SOI Asia Japanese Lecture 2011. 1. Name : Hylda Damayanti Puspita Ida Utami : Indonesia ITB - 2010

2. Country School Admission year

3. E-mail address: hyl_xx_da@yahoo.co.id Skype ID: 4. Communication enviroment for distance learning. v a. Polycom (group) b. Vic/Rat (individual) 5. Mother tongue : Indonesian 6. Can you speak other languages? Which languages?: None 7. Why do you want to study Japanese language? : because someday I want to study in Japan and live there

8. What do you want to improve? (*multiple-choice is possible) a. grammar b. vocabulary c. reading d. writing v e. conversation f. other 9. What is your expectation about this course? I can study about real life conversation, not only in formal text 10. Hobby/ Special skills (option)

If you have ever studied Japanese language before, please answer the questions below
11. When did you study Japanese? a. Im still studing b. 6 month ago v c.1 year ago d. 3 years ago e. other 12. For how long? a. less than 3 months b. less than six months c. less than one year v d. other 3 years 13. Where did you learn Japanese? v a. school b. Japanese language school c. self-study d. other 14. What textbook did you use? I dont really know what the title is

15. Reading skills (1. poor 2. basic 3. good 4. very good 5. excellent) hiragana 1. v 2. 3. 4. 5. katakana v 1. 2. 3. 4. 5. kanji v 1. 2. 3. 4. 5. 16. Writing skills (1. poor 2. basic 3. good 4. very good 5. excellent) hiragana 1. 2. v 3. 4. 5. katakana v 1. 2. 3. 4. 5. kanji v 1. 2. 3. 4. 5. 17. Have you ever taken the Japanese Language Proficiency Test? Which level? never 18. Do you have opportunity to speak Japanese in your daily life? If yes, to whom? a. teacher b. friend c. family d. other v e. no, i dont have any opportunity to speak Japanese. 19. Do you think Japanese is difficult? v a. yes b. no c. neither d. dont know 20. If yes, what is difficult about Japanese language? (*mark all that apply)

 a. grammar b. vocabulary c. reading d. writing e. listening f. speak-

ing g. conversation h. other