Student Code 16JMNC2701YI

Student Profile
Student Code: 16JMNC2701YI
Last Name:
Aoki
First Name:
Nozomi
Middle Name:
Gender:
Female
Date Of Birth:
01/31/2001
Age On Arrival: 15
Birth Place City:
Setagaya-ku
Birth Country:
Japan
Citizenship:
Passport #:
MU4375677
Expiration Date: 01/15/2021
Kagoshima
Country:
Japan
[email protected]
Postal Code:
891-0141
Native Language: Japanese
Address:
2-702-27-406,Taniyamachuo City:
Telephone:
81 992665290
Email:
Japan
Grade level (US): 10 th
Program and school information
Is this an IEP (Intensive English Program)
Yes
student?
SLEP (score):
TOEFL (score):
ELTIS (score):
Are you currently studying English in
your home High School?
Yes
Have you taken any Private English
Lessons?
Yes
How many years have you studied
English?
4 years
213
Have you participated in any High School
No
program in U.S. before?
Have you officially graduated from a High
No
School?
What other foreign languages have you
studied and how long?
Language 1:
Language 2:
Language 3:
Years:
Years:
Years:
CHI will consider requests from students who want to attend private school at a cost. Please indicate if you want to be considered for
a private school and pay tuition.
Please note: Select carefully. If you check “Yes”, your choice will be considered final. If you are placed in a private school, you will then be
expected to follow through with attending the private school and paying for all costs.
Private school selected option:
No
Your family
Relation
Father
Mother
Brother
Name
Koichi Aoki
Akiko Aoki
Go Aoki
Age
44
43
13
Page 1 of 27 (Student Code 16JMNC2701YI)
Occupation
Management
Employee
Student
Living with the Student
Yes
Yes
Yes
Your Health
Are you allergic to animals?
No allergy
Do you have any other allergies?
No
if yes, explain.
Are you presently under a doctor's care?
No
if yes, explain.
Do you presently take any medication?
No
if yes, explain.
Any medical reason or circumstances why you cannot live with
pets?
No
if yes, explain.
Do you wear glasses or contact lenses?
Yes
Are you vegetarian?
No
If yes, do you eat anything besides vegetables (i.e. fish, eggs)?
Are there any foods that you cannot eat for health or religious
reasons?
No
Do you smoke?
No
Do you understand that smoking is illegal and not allowed on the Yes
CHI program?
Will you be willing to live with a smoking family?
No
Your Preferences
What is your religion?
Not Religious
How often do you attend religious services?
Never
Will you be willing to attend religious services with your Host Family?
Yes
Will you be willing to accept double placement with another exchange
student?
No
Will you be willing to live with a host family with young children?
Yes
If no, explain.
About Yourself
List 3 things you are currently most involved in:
Tennis
Traveling
Watching movies
How many hours per day do you spend studying?
3 hour(s)
Which are your favourite subjects at school?
English, History, Math
What time do you go to bed? school nights
Do you understand that you must follow your host family's
curfew and bedtime?
Page 2 of 27 (Student Code 16JMNC2701YI)
11pm
Yes
what time do you go to bed?
weekends
11pm
What qualities do you value most in people?
I like those who have cheerful characters and
never speaks ill of others.
How big is your community?
Town
Have you ever worked?
No
If yes, please explain.
Why do you want to spend a year abroad?
I would like to be more independent.
What will you do to help make your year successful?
I'll talk with many people in English without
being afraid of making mistakes.
What are your future occupational and/or career goals?
I want to be an interpreter.
How do you think your exchange experience will help you in the I think I'll have more choices for my future
career.
future?
Have you been away from your family for more than a few days? Yes
If yes, indicate for how long and how it affected you
What can you tell us about yourself, your personality or your
habits that will help us match you with a host family ?
Page 3 of 27 (Student Code 16JMNC2701YI)
I stayed with a host family in America for one
month. I was interested in English and I could
find my dream.
I'm very active and I love talking with my
friends. I'm also good at playing tennis.
About your family
Describe your relationship with your parents and siblings:
We are very close and we help each other.
What does your family enjoy doing together?
We enjoy playing tennis and always go to hot spring baths together.
What are your family rules?
We make a point of having dinner together.
What responsibilities do you do to help your parents at home?
I hang the laundry to dry and clean my room.
How do your parents feel about you spending a year abroad? Do they support your decision?
They understand and support my decision. They hope that I will get a great communication skill,
knowledge about history and culture of America, and many other things through this experience.
Who should we contact in case of emergency other than your parents?
Name:
Chinatsu Dogo
Phone Number:
81 90-8886-0143
Relationship:
aunt
About your host country
What Do you expect from your Host Family?
I want to have a good time with my host family everyday with full of smiles.
What do you expect from the students in your host school?
I would like my American classmates to know the differences on the culture from America and Japan.
What do you think you will miss most during your exchange year?
I will miss my family the most during my exchange year.
Do you understand that if you contact your family and friends often, you will not adjust to American life? Yes
How do you think you will react if you get homesick?
I will ask my AC for advice and I will make an effort to get over it.
Check off the adjectives which best describes you
Active, Ambitious, Athletic, Competitive, Curious, Family Oriented, Gentle, Honest, Humorous, Independent,
Intellectual, Open Minded, Optimistic, Organized, Outgoing, Talktive, Thoughful, Tolerant, Truthful,
Check off the adjectives which best describes your family's lifestyle
Academic, Active, Affectionate, Casual, Independent, International, Modern, Sophisticated,
Student's interests
Interests and Hobbies
Cooking, Computers, Hiking/Camping, Movie/Theater, Reading, Traveling,
Sports in which you participate
Golf, Roller Skating, Swimming, Tennis, Track and Field,
Musical Intruments which you play
Guitar, Piano, Recorder, Singing,
Other hobbies, sports or instruments comments
Additional comments for PDF Application
Page 4 of 27 (Student Code 16JMNC2701YI)
Student's letter to Host Family
Dear Host Family
My name is Nozomi Aoki.Please call me Non. Thank you very much for accepting me. I would like to introduce myself. I was born
in Tokyo and moved to Kagoshima when I was two months old. It is the 10th largest prefecture in Japan. It comprises two major
peninsulas, Satsuma and Osumi, as well as many small islands such as Tanegashima, Yakushima and Amami Oshima. There are
many places to visit in Kagoshima. Kagoshima is nice place to live and full of nature.
I have a cheerful personality and I’m a hard worker. I have been keeping a positive attitude towards everything in my life. Also, I’m
very active. I have two hobbies, doing exercise and listening to music. Especially, I like doing exercise very much because it is
good for my health and when I do exercise, I feel comfortable. I like tennis the best of all sports. I play the tennis since I was a 7th
grader. I was able to win the tennis match five times when I was an 8th grader. I’m good at hitting the ball forehand. I think I’m the
best player in the class of tennis school. I’m interested in shopping and watching movies. I often go shopping and watch movies
with my friends on Sundays. I like foreign movies. Recently I watched Harry potter, Big Hero 6, Monsters Inc and so on. I would like
to be able to watch movies in English without subtitles someday.
There are four people in my family. My family members are my father, mother, younger brother and myself. My father is a principal
of some nursery schools. He works very hard. Thanks to that, I can go to school and live happily. I always feel grateful to him. My
mothers hobby is cooking. The dishes she cooks are very delicious and she is careful about my nutrition. I want to be able to cook
like my mother. I respect her very much. My brother is a junior high school student. He goes to school called La Salle. It is the
smartest school in Kagoshima. So, he is very smart. I have a black rabbit as a pet. I named it Rokku. She is very cute because she
is small enough to rest the palm of my hand. So, there are five people in my family. My family is very close.
I go to junior high school called Shigakukan. This school is very popular in Kagoshima because I can enter the high school without
taking entrance examination. I get up at 6 every morning. I go to school by train. When I arrive at the school, I play tennis with my
friends for half an hour. The first period starts from quarter to nine. I can learn various things in classes. At noon I have lunch with
my classmates. Everyone’s lunch box looks very delicious. After the lunch, I talk with my friends during the noon recess. Then we
clean our classroom. The afternoon classes start from twenty to 2 p.m. I practice tennis for one hour from 4 p.m. after school. I
come home at 6 p.m. I enjoy school life every day.
I study at least for 3 hours a day. At first I do my homework, review lessons of the day. If there are any problems that I don’t
understand, I ask my teacher or my friends the next day. I study English hardest of all subjects. I study English in three ways. I
make it a rule to study English for one hour each day. I listen to English for 30 minutes a day. I learn 20 English words in a day. I
will continue studying English and improve my English skills more.
My dream is to be an interpreter. Of course, it is important to speak English fluently, but also I think it is important to learn the
cultures and customs of various countries. So, I would like to participate in this program. I think I will learn the differences between
Japanese and American culture and life style. I can become more independent. I like to communicate with many people and I
would like to make a lot of American friends. I would like to go study abroad to make my dream come true. I’m looking forward to
seeing you all soon.
Sincerely Yours,
Nozomi Aoki
Page 5 of 27 (Student Code 16JMNC2701YI)
Parent's letter to Host Family
Dear Host Family,
We are parents of Nozomi; Koichi, the father, and Akiko, the mother. First of all, we would like to thank you for hosting Nozomi. We
are very grateful for your generous offer. We would like to introduce our daughter, Nozomi.
Nozomi is a positive and hardworking girl. She works very hard both on study and sports. Because of her positive nature, she has
many friends at school and always smiles and laughs with them at school. She plays a leader role at her class and is known as a
most reliable girl among her friends. When her class had exhibition for school cultural festival this year, Nozomi prepared most of it
as a team leader helping organize the class. Ice cream party after the festival with friends has become one of her memorable time.
Nozomi started to practice tennis since she entered junior high school. She practices every day by her self other than regular
practices at school. She started to play at private advanced tennis team to improve her skill. Now, she is a main player at her
school tennis team and also enjoys playing with boys in a varsity team of the private school. Her younger brother, Go, also started
playing tennis this year because of Nozomi. They like to chat and play tennis and table tennis together when we go for traveling.
They are like best friends together.
She was born with hardworking nature; she has been trying her very best with study, sports and every other field in which she was
interested. She has visited America for few times with short homestay programs. She found her dream to become an interpreter
when she turned 15years old and told us that she would go to America again and study for one year. We were very proud of her
searching the way to achieve her goal by her self and works harder than ever in order to make it realize. Since she applied to this
program, she has been studying a lot to improve her English everyday until late at night. She made the first place in her grade at
last exam. Nozomi has a strong will and toughness to do her best in everything. We are very proud of her.
We have to mention how she is helpful around the house. She helps the mother with cleaning up after dinner, doing laundry and
ironing. When the parents are not at home for work, Nozomi cleans up the house and prepares meals for her brother. She let us
know things happened while we are out and that how the brother has been doing. On weekends, we enjoy going for shopping, hot
spring together. She let us hear her daily life she spends with her friends. When she needs help, she is very open to share her
stories with us.
We can easily imagine that she tries her best in America as well and she will have a wonderful year with her host family and people
she will meet. We believe her school life in America will be fruitful filled with smiles on her face as well as people around her. She is
looking forward to meeting her family in America. We hope that you will share a wonderful year with Nozomi. Thank you in
advance.
Sincerely,
Koichi and Akiko Aoki
Page 6 of 27 (Student Code 16JMNC2701YI)
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Page 11 of 27 (Student Code 16JMNC2701YI)
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Page 12 of 27 (Student Code 16JMNC2701YI)
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Page 13 of 27 (Student Code 16JMNC2701YI)
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Page 14 of 27 (Student Code 16JMNC2701YI)
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Page 15 of 27 (Student Code 16JMNC2701YI)
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Page 16 of 27 (Student Code 16JMNC2701YI)
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l ■ ●possosson PH【 h亜 o「 Hse oFi1lesal dm宮 o isp"rubSted
2 Studenほ ⅢⅢst ab:d● Ⅲ th。 laws oftbe h。 車●m。 ￨■
s Sludents drs,olal ow迎 lo PosttSヽ P"● has● or dlink a coい 。Ⅲc beverag苺
4 Stude ts的 に も。￨,l owsd“ pH「 chast possess 。lsい 。ol却 ilS Oran】 守ぃ
s
Studonts are nel,onnitedい
dr、● oぃ y【 ェol。「 vehcre
whi e puiol,dttngモ ェthtt Cm P「 ogranl
l Students mは 〔コotpart Patein an】 、本Ha oonは o(or soxml activi● 2 hath nゃ prⅢ Ⅲale
4り rrrrra胡 あ″″ r/rr″ 筋 に ιrrr76′ り
“
″ rrr“ チ才,■ 4
, 3,la■ students arc nd pe
ゆ ″″rrt価o加′を お 材 ss″ !ヵO″ め夕97ぃ 暗 、
rrⅢ ″
″′セヵ
"rr″
:"
“
的 lo l)ltduse tobacco,的 duりヽ Sぃ de
lls are noi allowtu t6引 .。 卜
f hi he host rarn“ y
holne wiulout,emSsoれ
“
SAldenS must aい w4本 be ttbre oFthe'resPonHl)111,as l】 ●hコ ige stutoコs and nake n del● 価 古ぃ0● IF64 0 reFrestrヽ
thei coun,in a poslrivo ma lne■
Snldo■ はhlHsl f91 ow Nhool mlos li的
なsohos dal卜 c。 ■pl● le all、 ホool asstrtments must Pふ s ali Ciassts ttd
n atleasta C No「 ngo
io Sttenヽ mN sp●ak断 81ヽ h un】 oた n Winは h・ 、 sc itheirown com■ 予
n Studentt arc no(Pem“ によい P』打cⅢ 口に nsゆ diVins hm=宅 nd.巨 bungeejHm,ぃ g Parao的 Ⅲ Ⅲ
コmp ng orany。 (hor
ma【 ■西
activill● sd● ●
moと dttng●
Ю us b】
cHI
E Sヽ 市ebⅢ are DOl pe it〔 ed(o viす t tsuch ,laCes tt p。
i3
∞ mogaFhi WebSci
Stten、 shoH10 1硫 ■mttll13 brm“ ba』 Phoこ EcJヽ
1、
1。
。graPhic shoFS adutt theaに 、
ostaSl｀ ｀nen、 。r
uld.P釘 ●
nヽ ald inms ald wllbennl..五 lyに S"nSbに
f6rSⅢ h cats lt sthe mdent、 res,ons baを け ゅ makeSuⅢ amヽ J s are pattい ofsr●
calls sh。 ■3 6o blled的 ‖ て
or mddo wih a preFata nに matioぃ 。は lng oa u
】
ari ltilli【
1●
即 ng thc PrOgam lntmajoこ aI
“nu ber of● m西 1(onlnHntajon ls thetr parttts a ld mmts lntemot accc、
Studoこ は sh。 ■ld thSt古 ●
is at Fhe
discrer oH sftheヽ ぃ(hni】 (Soo,“ so17 Fohヽ 1)
li sHmedは mぃ 体 hOⅢ Ⅲ wo“ 品 r thei boH Fa ldies attd att tt a m● mb● I sflhe FalliⅢ by f61 owins fa t,rutt Ald
“
的lunt加 :y hJPing with iniけ o稿 1● S
I Stteatt mu“ mtdヽ cws thar tts、 ゎmiけ ヽPi Vate arsus with oders
IT Snldent canHα ohang● いost hr111モ os and“ hoo s at wi川
加 StudOぉ t are nsI Pttmittd i。 取 。。lHPsけ hmsよ ⅢS A lr p with the hぶ t Fa llj)a tthOol=r● J)o「 ahV価 0「 at4Hi
Perten ts剖 1。 wed iFp● IⅢ Isston f riい o nalurd Pa,nS iS Shrnited beFe∼ hand
】
,Sttdenls ttIRt s 16w resped fo all C,HI Ⅲp● sen alivos and f● l ow iher instt.“ 〔
ons
,o Stude lls are not al ow“ dto mよ olre are市 宮dectsions、 ■Hc Par tillaling ln dl● Ctt p的
ヒヽ
ゎos bedy
=rmisnCh本
pけ 。u St oI揮紅ng n_ed
J sha.lls aroゎ olalowld b wort、 hilt FTtiCip“ ng nthe C,■ ,regl■ m
Fat=“確 わ 〔B芝￠
り ″ rFr。 うクッタ,。書
■
め西 ″″ 々 rrrr rrr rrrFTarヵ れタスIP
"1●
,rrarrrもsd抽 加 れo CPrr″ ″
ク抑 加 節 ″セ
r"刀 ″あ ヵヴ r71タ エア亨よ4
″ rI。
rat「
rr
"″
“
r●
7"Z↓ 抑I
oF tludcn“
Aoそ
防 Ⅲ
? /,/2,な
:
a“
S13naは、oFP3 ntand7or C B di皿
Signtu● 。f Parettt ardle1 6uardiani
酎g
何 ″2ray
あo″ ″ ョ″転 4商
wEほ 07● ″ 2″ 的 1減,″ ″24rrSra″ ″
″ みな 〃
ノ が ,`″ あ
`“
"H確 '″
“ "匂
'は虚 乃 ″ Pr々r4加 切 ″FrrF4拘 あ r22"あ りに
す″ ″筋 西 ″ CFrS夕 輌 ぁ
軌 ι貶 ″あ 昭 竹
S卸 を価
a""加 ″
_
au● 。f be sondng ttencV:__
",
ね セ湖
十
″繁 ン ″
″ 桟￨ど
′
0,/
■ゥ
7 /P/う o/ぐ
Darc!
:
ア よ7′
晦
!
Dalf:_Z立 地 生 埜 す
琉
擁
OC■ 1却,Sur● A,p ttv O,013
Page 17 of 27 (Student Code 16JMNC2701YI)
ヽt un往本筋 db● feloWing
Vク 2′
′
NJ■ o olA,Pllo』 i!
l All oF CHI AYP hostttmllos art■ olunte本
2 ,に
査守 o b re■ lbHぃ o ule hos、
faml転 he SCR● ol or C口
￨く
"' Aレ
飾 any exloこ ses)ヽ deFhene
ィ
chltes or d unages he
snldent caぃ 。s
3 Us●
Priv〔
of corr puに も odi p「 onesい o6怖 pS
1●
J苺●尽 。ra叫 。lher
eに ctronに
d"te`ap古 もにgeぃ 。〔と
ght ifthヽ
go ls abtted (■ ●●
oは oHu● nce ma】 b。 (ernponI】 ●oniscaton dr loss ofrig ltto uso ule devic.
“
4 C町 oannul gヽ ちrttt00
gに duat。 ュ 。、
■hd dⅢ lotna or gradc Placmentleve An o、 ■Pt O■
retardS tO grate plarenentic■ ei fs,sⅢ d● nts I● qutring Co〕 vatida(bn
WH
使 ぃato wth
s
rhe stud。 ぃ、ls resPo,si6 oい rけ モ
ng ng Ⅲ the u S arIohc atia■ sけ て
,tolⅢ ●MOST
RE● Arr=浄 des Mnslated
6
AHaコ ロnge nen、 おr oblaithg tta l【 ■,● dlld ha dに Re CCI Valita古 on oFsohool woよ nre sttd● ぃts And nahnl
p西 ■Dは Pα ttnat resPoコ sibHiけ ｀1い 。■
rranglme lts Fsr ConN41【 daton【 ndst bo l。「SOnal y conIPに tea bン Lhe
sludent beFoⅢ leNing並 【
サS o「 oD Oな 3(:onatに o wlllじ ocharged CW isnol【 ●。
●oompl● 1loぃ of
「」、
POnSbl● 市
tanstt pls er 6nvo1 3alion ho「 ts CHl● さ
o■
し
に
fdl
mail
Dg。
cesls本
ciatqd
will
Co5v,h
daむ
的
on
。
「
N4H「 前 ,aren｀ 6心 Jtts other ret,ives md titnd。 ぃay no(vヽ t hesnd●ntattng tl..xoha把 〔pr6gram CM
las f6und hatふ its iom hon■ cα ぃぃ 。anSC Nrsndy d`mpl【 v● b ulo adJusmentPrdCttS uStS mus(laに
into EttF l軌
7
ptl● ot the coDCluSお n of he PIo=rm V Sttsisstttd 14k●
h● 苺 ヽ mi,lo,ゆ
Vモ
｀■41SO undertlmと
dosccemmodttbns Oい
rSSo〔 vallods
or visis AIo dD'aHOW・ dコ
at a bd hoて o16thcr hm o、 FE“ lng he
an eln● rgoHげ
shu市
じⅢ
dlat the student is not aい 。
wed te r● ⅢⅢ Ⅲ hヽ あ●
rヽ oぃ o的 unヒ 】du ns tho prosは
8
At Chrishl苺
9
Shodd ule sttdent do llbP加 】seD。 」S uhess,hdunngtl.lin、
1lmo(D● o印 ■ berlい olヽ (FTlげ 1け
。 Fthe
stl denlls to spend ul。
A"闘
、he
win higherに
m
llt ramll,
i aLA,Pc oFs前 oHs ttthg 6sorder or
scrious psyth。 loと モ
oal disd der whilo Pttc P“ ng in the Cm proglモrn lhe md● lt wlll be d stthnsod io血
tO his/her home co血 け hnmediコ にb at hiSher ohvn spense
10 SⅢ dent・ InJst h"。 enmBh tanttatt Sk前 卜(o in前 ぃⅢ an a ld lt htlio● in tho 4m・ ヽcttl hish、
AT ald
wllt r笥 ■
m
い
。。1】す。
ぃ
軸●●OSSfall,
1l lfsfudell S atntted Frem a high sohool、 h‖ ●。■lhe CHIprsgmm d● sludent Mu beropnthH● d back Ⅲ Ⅲヽあer
home。 印加中 4nd hiSho「 v sa wtHヽ e re■ to』
hns sn undisclosod P∼ 々xisthg nl● dicat ol,wcho103【 041 00 1dition or he sⅢ dtntis uk ng any
undsdosed medctt on、 CW hド he ttght Ⅲ ■sぃ 忘 ￨い o前遠entttn he AYP,ro野 m slter gettng an
本苺
l tem A10制 ,い ぃ o14h anJOrぃ ぃ lolog st CM htt the tghtts lnr 4 ule sn4」 ●●た0■ NIP眼 め、and
`sme■
sh denls市 使 蕊 psnstい にfer nl cosヽ hvoⅢ 田
13 Ahletr ellgib111り 。r Ftttipa6oュ hoい or oH配 。
旺 lu ar苺 市vitt ar● not ttaranteed
12 1fheH■ dent
1を
i4NVe血
4 1emore ogⅢ ,that wo AaH ral PIenは
nd sNdAntsl diSCtosed a“
ediぃ ,PhFtmaCeultat and
“
,WOい010な iOai inf6mlat on
15 コⅢ nれ はl fu li,tsrespms lに
1)riぃ
ung血 !the sは dtnthas
ln odd tm古 o● ts n3即 a allec oす oblaining a bm■
pr● ferab:oい ぃo a tObit OI oredittar4
suractent mmey tta tajle lumtt he Wara l
ac● ou lt and host lnd1 11ぃ aI。
■ot Po i“ 。
1 lo● oも 1印 Itis
Tい o sclldhg attEcv stnfF has血 :ly oゃ lallled伍 o
above ageobeJls IV● LAV`よ ほOr● ad al d fDllv
HEderStadd(bos● ruLsof CMヽ AcatsE iC Yttr,的 gram and igr● e to abido町 thebl
Sヽ 8■
awe tts、 コ●
“
智
t●
A,た
N0227jl′
)
,
。n.1
“
Si即 4hェ orPtlrcDl anJば GuBIui3■
Sietlatt rt ormrcnl an血「 価 加
S ttaturc erhe send lltFASen叫
9 /3 /ル r
n五 Ⅲl,/D。 ア ヽ
ぃ
怨
Dati
i
D止
tan!
Do●
:
な
枠
主 多
″
必
￨ヤ
F。
Page 18 of 27 (Student Code 16JMNC2701YI)
…
,12
―
0011村
“
″ ′ F‐
“ udlntべ
,ヽ
rF｀ い 弾 01'
N‐ e
〃ゥ,"l rl。 た
oFAP,1に コ■
I
W● g alt Cmtw41 HOm● 車げ htematoぃ o(CF11)“ s cmPl。 メ●
。S Acadenit Coo由 41atsrs he edicl o■ al instmょ on
wheF the shaaltis tts印 o4and he rttstド nm“ ンor fNl diS Win whom the sl血 ert mal ive hそ に)at(heir 4● cis on
and if h● edet althe cost eFde stl de lt or his/her PaⅢ ■
、。r egn s lardtans h easo ol軒 ptnses N、rn。 的 verage of he
ヽ
ぃ Iコぃ。●pci【 け 。。vtrint the stadcnlは じPower ts Pl“ ●lbe Ыndent h a heゃ モ
均lor na■ y oberinsliⅢ tion ttr my,P●
ofo、 :立口 or meatat d。 。ぃr fer hi切 〔r tr●atmcnt
“
W● g anl C配 )its emP19j tt Acadml● C。 げ
■●
st
印
Fa liけ
m、
he educatlen』 inshttion、 heTo lに
st■
dont sぃ signed and lい ●
.orへ
gal
」●
lvo,a11■ ecessコ ,PemitttOns io actヽ nは o,II● nttす
esPec any n tters的 。 ぃ whttltr medifB!or sul r n。 ludin=こ e poss■ H5。 f ttHniSSiO｀
。
「転mtlos w h whom thesttdcnt`市mⅢ
ardians"h any stu“
。こ
for"rgicaJ o,oraltOns or any other treattho● (d∝ m●
`necesso,
hVe auul"2。 cHI:、 clnP,9y∞ s Acatem o Coordinaい 、 the educatな onal tt st ulお n whllto hoも tudoぃ ェヽ本stsdod ahd
tho Ho“ Faniけ sr FhmJに wih、ヽom ule studentlr aA nve O"tum he srudent"the∞ 岬 け sfoig ntt hesl」 tentヽ
00St研 4a10f ule lo宮 al al ard七 狙S or PaFlnに lf nesess与 lo sub【 ■■ 【
■edical teaunent ir th、 i.dcemed llecessar2
heお
mentお
r∞
SA●
●
1時
to住
nsdlarion
wm
medta
ttmmrmes、
た。
。面血 nat at ho lt ofttsningい ヽ
け
Ⅲ
l●
4ooomelt he shdert e可 り s g6。 d healuL ul証 姉 動 。r modo』 に COrd hdudtt h ho sⅢ dAnt aP,HcanoH is的
ComJtt anathょ h。 価 entヽ ntぃ 。ぃ ag● h莉 叫 Httsicl sFOt acdvけ
We sra i cHI ls匂 ぃ,も】●os A胡 ●mt Coordinaい ぃ tho edu● abena insumion wh● Ⅲ he sIId“ A(｀
いo
mstF皿 ↓y
or fan ites w 41、Ⅲoni
heれ deれ m伊 ⅢⅢ
●価
d
aS点 留 o4aぃ と
thb=pl・
,emtss on to oot o■ otr behalf h o■ ャ
hhs o
POSSIblC represensttOnじ ●bre dle locdl authorllios
rnis authsEZatttn s a11に vttIId ttr u●
的 め ,1● t
A7,Z「
Sittntt re of Student
duratio■ ofth● Cm DroBrm n WhiCh ihe shttentls Parlに
"￨
■りたィ
Dalo
Paling
9 /4 /2●
n■ ″お′
′
S
吻
"′
Signabre ofttnt加』dr
D症
Gヱ 配 iani_
:
十
"セ
D競 、
S tnamE of Farentand/er Cuar iani_
Ⅲ
″
““
S夢 oい ofhe Send ug Agenけ
r●
Dot●
:
/ク
:
(虹跡
Host imllyl
あり ′ 】
り
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/会
,/りr;
′
】
り
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D封●
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Aヤ ふ
ヒネ
イ
吻
"′
FOrEI'13
Page 19 of 27 (Student Code 16JMNC2701YI)
O CHI AV)ヽ
udeぃ て
大,,電 〕 12。 lS
N□■●ofAFPhOant
D● ■ Stt dent and Pa e lts,
7ゥ
殉i Aυ に
1
"″
Par e paliltg■
lh。 人 caと ￨コ lo Vcar Pmttrar is m a嶺 、■hde F61る oth sttde■ls and parentt No mat“
howに uch y● u
ed nrra d b and,上 的 rd r6r dlt txo a ge ttP守 た ュ唖 ゥboh stud● 、ほ Ftnd Parch`win却 Ⅲ 的 u」 l aPe市 oと of
adaplanon mt adlHⅢ ■eni Maby sは 古↓1ヽ 的 frerを 切 n cuiture shotk wben tnⅢ nISt ttve in th首 「 host o側 ⅢⅢ Illり
mal hN● ●Xpe。 ャ■1。 に about hoJ thh苺 亜●uld be dat arc unrealishc Beは wン Ou wlヽ Snd s,al gies to hcl,yoJ dea
have l。 は
w d oulll■ re shook
oJhat lonc,、 。atじ d or hsmへ k ttd ucPresSed wh:に goD!て臨 口g l thc adJusuntrnt pttcess
Sttd如
i●
`mttanftci
so■oい ot are pょ oF he,,ledi adlustmert串 〔o Atulesコ n.“ me naⅢ rnl,伽れヽ mゲ 能 lh● ploss
Hlese are
ernoi伽
(o assist thetr s。
封 Fげ n reso中 ul:bose issⅢ s P loゃ boさ Nured ulal cコ 」wH be heIPing}o■「 child th「 。ugh th。
adJWSmen eッ oに"1帆
and you can be oFgr● Rt assislance toメ Ourchmd mu ts cHiby disc、 ss ns art3■ 軒 chB Ⅲ abdebv h●
おHo】 ing
l
NTEIt「 4rltjTHAL CaII卜 I AND ESIAIL CHIに nOIs hat stte■ s
and th● tr,arent W Sh to be tⅢ
oolnlnuntaton wtul sAe SdOdla Hじ H● vキ t60 much contct oan hinttr adlHtthelt Cm undcrstulds hat duringい o
ir“ w● .k yoじ wdld whtⅢ c。 ― LAtaeヽ th you,scnね o,か に
r i c4StOb● ol Ⅲoこ nes Cm woud alPttv。 い｀
●ommndittten danng碇 4trst w悲 」o、 〔ve■ ■om the ttco ld w● ●k on、草 郎 〔tha【 〕ou and you(soWdo」
limt(
tausn tu no more han N011に ヽOS O● rい Onth W uleobnmicatiol so e容 1ly a■ ala1le we tぃ 。w hal t =lter
sdifncuI
mm o。 価 血 cathg bui ntt docadcs ofhone“ Ⅲ 瑛 Per enCe w。 臨 oJ hat hryou「 cヽ luぃ atlust he′ Sh●
OCCdS tD ntgraに intt and 6ond IIn tl1lⅢ slねmi】 ぃ m,1● 】 ヽ L alさ 。 ast ulatyou discuss hヽ 口。liげ widl your child s
frlendsな nt other relatl■ es and杏 (ther tol m“ PhOne caⅢ s “ttWor■ nall n he nbov。 さ
oh●dul● Pに oso undcrs And r atif
CHI Feot thatyouぃ。Wdaぃ tertt nd ndJH“ ng duoい nc∼aing o31 pho■ oaぃ Ol re ma“ oommunifa“ o● No wlllmi
thosc Neruco oFcsnlmぃ た新 on le bo(clsurc hat wursc Vdttghtcr w31 be abL 16 adjust o thar ht mtttⅢ PIngra n
oo―
口
Is Ⅲ Ash
2
Vお IIS‐ Nardlal parent、 sib inss oth● r ⅢiaⅢ Ⅲs and衛 ondsコ● no(3 10Wed lc visi ult stl」 d.ll durl=dle
はnange Proga■ II has ttund thtt v stt「 ●n home can心 ●●
xtに nd】 d｀ nouve〔 。thc ad u“ コentPrSCess We ask
hat aiッ v strs occw al th●
hetr chiJd mlof be,的
●
onolusioR
3fthe P「
ogr‐ When fanliけ memb。 ヽms2 wish io● om● いヽo血 Anebca slgn
、shsull 16よ e reNrvaい oぃ s al
eranl a ld tra● I h tho hぃ 【
●
ountt beFsre retuming holne V siぃ
slooAl hetel rahtt than exttting ule hostれ nl,(prnvid●
home∞ unrts durhs ulj Pttgrtt aF■ e■ Ms ts arc aHo、
sい den9
3
HcoommoCatons SⅢ
■dモ Ⅲ
ar ernettcnCI SiⅢ`l31iOい
ls are
no1 4110Wed(o
ctF m tC
Od,t●
い。S,【 r41lZa“
oぃ hOi「
oith●
COUNSEIINC■もu
nav● oeitt a Phone cal er■ Hau nesM野 キ
n which)our scWdmJtNr aSpearsい be
ond upset hい ヽ cas Pに セ
時 advis● 】o,「 soEldttghi可 海 sPttk widl he hos(Ia llモ lL Cm∞ 。dinabr or
Aoado前 oY● ar Adm価 statoL Ctt H■ 臣ヽ使 h● to prsh泊 ●。。unttrng側 ,P血 o assヽ t veur"Dれ aい す drmgh the
adJusu le tprt● ess Pに astr d6 not cttt ul● hosi Caコ I scい ool or eoordhattt d:Ice■ IW.ast thatyew。 。n14“ the se■ 3ng
“
agedり ｀
直rin yow.。 mⅢ
dtslressoと
4
TO■虹
IIVIAIERSION me CFtIハ ヽ?s toま gn● 01o gⅢ じymrsor.r aushttr rに 中Po的狙う
寸 tO
SIu】
imme「 se in
thoに os(ooコ nけ mmJ。 範dl価 即処 e ll｀ a nttla tendenり fer stddents to wtt le m∝ tand sロョk with Ctllers iom【 い
●
same cu l‐ EE30r Who sPcat he sFtm● ian却 宅 o口 ●as● ●nooHng● yow sowdauJ● rto immettetヽ 1,け a,Pttachin“
(bls sxptten∝ 宙b ano,en ttd tten【 !け BHSⅢ do Poた o,alioぃ os― untat on a wlllh卸 ぺ 101d吼 and asmit wl
ensur● su● ooss
Tho seコ d:Lg ageコ
lL● se
げ
￨は ThIIS Futt exPlat■ Ca tl e abぃ で agrcemo■
rules oF CJ〔 's A4dealに
IAtte Si印 師ュ● 市 Stud●
FI
Vear,れ gr資 旺 a□ a
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Page 20 of 27 (Student Code 16JMNC2701YI)
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Page 21 of 27 (Student Code 16JMNC2701YI)
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Page 22 of 27 (Student Code 16JMNC2701YI)
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Page 23 of 27 (Student Code 16JMNC2701YI)
Student’s Photo Album - (two recent pictures of the student with his whole family)
Close to each picture we have a brief explanation of the picture.
This photo was taken when I went to the history
museum with my family. I learned many things.
This photo was taken when I visited Kumamoto on the
family trip.
Page 24 of 27 (Student Code 16JMNC2701YI)
Student’s Photo Album - (two recent pictures of the student with his friends)
Close to each picture we have a brief explanation of the picture.
This photo was taken when I participated in a homestay
in America when I was in 8th grade. I am pictured at left
in the photo.
This photo was taken when I visited an Inari shrine in
Kyoto on a school trip. I am pictured at right in the photo.
Page 25 of 27 (Student Code 16JMNC2701YI)
Student’s Photo Album - (two recent pictures with student's interests)
Close to each picture we have a brief explanation of the picture.
This photo was taken when I played tennis in
Yamanashi on the trip.
I went camping when I participated in a homestay in
America. I had a wonderful time.
Page 26 of 27 (Student Code 16JMNC2701YI)
∼ 1 ． 1 一 ′ I I 一 わ ー ∼ 一 ′ − い ∼ ● わ ー 1 ︳ − − ● I I 1 ■ − − 、 ● − 1 へ 、 ● ・ J − 1 一 一 − ・ ● 一
﹂−■﹂．ヽ㌧﹂い≠ノ∴・、．
Page 27 of 27 (Student Code 16JMNC2701YI)