Name:

University:

e-mail address:

List all Japanese language courses you have taken at any university, college or community college, beginning with the most recent.

List other Japanese instruction you have received.

Your native language: ____ English ____ other (specify)_____

Check if either of your parents or anyone else with whom you have lived for a substantial length of time is a native speaker of Japanese:

_____ mother _____ father _____ other (specify)_____

How many months/years have you lived in Japan?

TOTAL number of years of residence in Japan _____

From year _____ to year _____ (age _____ to age _____)

Please answer the following:

• 1. What is the main reason why you are studying Japanese?

• 2. Why did you decide to come to Japan to study Japanese?

• 3. Do you feel you are accepted as a member of your host family?

• 4. Do you speak mostly in Japanese with your host family? _____% speak in Japanese _____% speak in English

• 5. Can the members of your host family speak English?

• 6. What do you learn most when you speak in Japanese with your host family?