Attached Form 1(related to Article , paragraph 1)

Residence Application(International Students)

Year

Month Day

To the President of Hokkaido University
Name of Applicant

Wasuwat

Petprakob

Name(with Jpn. katakana)

Signature
If you are not in Japan, you do not have to sign here.

Nationality

Thai

Date of birth

1991 Year 3 Month 28

Day
Gender

Male

Female

Per the information below, I submit my application for residence to the National University Corporation
Hokkaido University International House.

/Faculty

/ Details

/Department

Affiliation

/Supervisor /Faculty

/Year(The year in October)

/Title

Intended Period of
Enrollment

Residence
Period
Preference

From Year/Month/Day
To Year/Month/Day

Single room1

From Year/Month/Day
To Year/Month/Day

/Keiteki-ryo dormitory( /male /Sosei-ryo dormitory(

Accommodation
Preference

/female

1
Hokkaido University International House Kita23 Building1
2
Hokkaido University International House Kita23 Building2 Only
female

Hokkaido University International House Kita8 Building5

8 ( )
Hokkaido University International House Kita8 East(Only male)
regular size room
IH large size room with glass
ceramic stove
large size room
Couple room

Hokkaido University International House Kita8

Family room
Hokkaido University International House Kita8

Present Address

Family Residing with

Applicant

/ Please fill in the overleaf

Name
Date of Gend
birth
er

Relations
hip

Occupation,
etc.

.
/If the applicant or
applicants partner is
pregnant, fill expected
month of birth in 8-.

Tuition Classification

Japanese Gov. Scholarship

Foreign Gov. Scholarship
Self-supported

For couple and family room applicant:

Please check tuition classification below if your family residing with you is
also an international students of Hokkaido University.
/Japanese Gov. Scholarship
/Foreign Gov. Scholarship
/Self-supported

Other

Experience of the present or past occupancy at the international House or a
student dormitory
/Yes

(Term of occupancy : from year/month/day to year/month/day )

(The name of the

dormitory.)

Dormitory (Keiteki-ryo, Sosei-ryo)

1
Hokkaido University International House Kita23 Building1
2
Hokkaido University International House Kita23 Building2

Hokkaido University International House Kita8 Building5

Hokkaido University International House Kita8 East
Couple room Family room

/No

/Arrival date in Japan

2012 /Year

/Month

29

/Date
/Fixed date
date

/The hope order of occupancy 1

/Expected

1.
3.

Kita8 East large size room 2. Kita8 East regular size room
4.
Kita23 Building1

/estimated month of confinement /Year

5 /Month

1 23 2 8
Hokkaido University International House Kita 23 Building 2 is for female students and
Hokkaido University International House Kita 8 East is for male students.