年度 月期
宮崎情報ビジネス専門学校 日本語科 Year Program
Miyazaki Information Business College 受付日 年 月 日
入 学 願 書 番号
Application For Admission
*枠内学校記入
School side fills blank
学校法人 宮崎総合学院
宮崎情報ビジネス専門学校 校長 殿
1. 申請人 Applicant
国籍 生年月日
INDIAN 2003 年 6 月 30 日 ( 21 歳 ) 写 真 Photo
Nationality Date of Birth Year Month Day Age
正面撮影、1ヶ月以
男 女 内のもの、横3cm、
性別 ・ 縦4cm
漢字 Sex
Male Female
氏 名 ☑ ☐ Front view, taking in
Name Family Name Given Name a month, breadth 3cm,
In 出生地 KOZHIKODE, KERALA
length 4cm
English KUNIYAYIL SREEDHARAN SREERAG Place of Birth
配偶者 有 ・ 無 職 業
Material Status
Married Single
Occupation
PREPARING TO STUDY ABROAD
☐ ☑
現住所 KUNIYAYIL HOUSE, PULIYAVU POST, PARAKKADAVU VIA, KOZHIKODE, PIN:673509, KERALA, INDIA
Present Address
☎ +91-9645169152
戸籍住所 KUNIYAYIL HOUSE, PULIYAVU POST, PARAKKADAVU VIA, KOZHIKODE, PIN:673509, KERALA, INDIA
Permanent Address
☎ +91-9645169152
旅券番号 X9023438 発行日 2023 年 6 月 7 日 有効期限 2033 年 6 月 6 日
Passport No Date of Issue Date of Expiration
Year Month Day Year Month Day
2. 家 族 Family and Relative
続柄 氏 名 生年月日 国籍 職業 現住所
Relationship Name Date of Birth Nationality Occupation Present Address
father(父 SHORAP, GOLD SOUQ AL GHANIM, DOHA,
) SREEDHARAN 1969 年 5 月 18 日 INDIAN MESON
QATAR
KUNIYAYIL HOUSE, PULIYAVU POST,
mother(母
) RAGINI 1984 年 3 月 4 日 INDIAN TAILORING PARAKKADAVU VIA, KOZHIKODE,
PIN:673509, KERALA, INDIA
SREEHARI KUNIYAYIL HOUSE, PULIYAVU POST,
younger
bro(弟) KUNIYAYIL 2013 年 3 月 4 日 INDIAN STUDENT PARAKKADAVU VIA, KOZHIKODE,
SREEDHARAN PIN:673509, KERALA, INDIA
SREELAKSHMI KUNIYAYIL HOUSE, PULIYAVU POST,
younger
sis(妹) KUNIYAYIL 2013 年 3 月 4 日 INDIAN STUDENT PARAKKADAVU VIA, KOZHIKODE,
SREEDHARAN PIN:673509, KERALA, INDIA
3. 学 歴 Educational Record(from elementary school to the last education
学校名 所在地 入学年月日 卒業年月日
Name of School Address Date of Admission Date of Graduation
GHSS VALAYAM P.O VALAYAM-673 517, KERALA,
(ELEMENTARY) 2009 年 6月 2016 年 3月
INDIA
GHSS VALAYAM P.O VALAYAM-673 517, KERALA,
(HIGHSCHOOL) 2016 年 6月 2019 年 5月
INDIA
GOVT. HIGHER
SECONDARY SCHOOL VALAYAM, KERALA, INDIA 2019 年 8月 2021 年 7月
(HIGHER SECONDARY)
UNIVERSITY OF CALICUT
CALICUT UNIVERSITY P.O,
(EDUCOS ARTS AND
SCIENCE COLLEGE)
KERALA, INDIA, PIN:67365 2021 年 10 月 2024 年 8月
(GRADUATION) (KUTTIYADI)
4. 職 歴 Employment History
勤務先 所在地 職種 勤務期間
Company Address Type of Job Duration of Work
年 月 ～ 年 月
年 月 ～ 年 月
年 月 ～ 年 月
5. 日本語学習歴 Previous Study of Japanese
学校名 所在地 就学期間
Name of School Address Period of Study
17/1924 B9, FIRST FLOOR, AMEEN
JAPANESE LANGUAGE ACADEMY COMPLEX, EAST KOTTAPARAMBA, CALICUT - 2025 年 1月 ～ 2025 年 5月
673002, KERALA, INDIA
年 月 ～ 年 月
日本語能力試験 (Ｎ 5 ) 合格 J-TEST ( ─ ) 級合格
Japanese Language Proficiency Test Passed Level Passed Level
BJTビジネス日本語能力テスト ( ─ ) 日本語NAT-TEST ( ─ ) 級合格
BJT Business Japanese Proficiency Test Score Japanese Language NAT-TEST Passed Level
標準ビジネス日本語テスト ( ─ ) TOPJ実用日本語運用能力試験 ( ─ ) 合格
Standard Test for Business Japanese Score TOPJ Passed Level
J-cert生活･職能日本語検定 ( ─ ) 合格 JCT ( ─ ) 合格
Certificate of Japanese as a Foreign Language Passed Level Japanese Language Capability Test Passed Level
PJC Bridge ( ─ ) 合格 JPT日本語能力試験 ( ─ )
The Practical Japanese Communication Exam Bridge Passed Level Japanese Proficiency Test Score
6. 卒業後の予定 Plan after Graduation
☑ 日本での進学 ☑ 日本での就職 ☐ 帰国 □ その他
Continue to study in Japan Find work in Japan Return to Homeland Other
7. 日本語を勉強する目的（日本語を習う理由を及び卒業後の予定を具体的に記入すること）
Purpose of Study(Outline reasons for studying Japanese and Plans after graduation)
My name is Kuniyayil Sreedharan Sreerag and I am writing this statement of purpose to express my sincere
interest in learning the Japanese language.I hold a Bachelor of Arts degree in English Language and
Literature, which has provided me with a strong foundation in effective communication through the study of
diverse literary [Link], it is my passion for Japanese culture that has led me to pursue the study of
[Link] watched various videos and vlogs that showcase the stunning nature and traditions of Japan,
I am eager to learn more about the country's unique culture, history, and values.
My ultimate goal is to secure employiment in Japan.I studying the Japanese Language Proficiency Test(JLPT) N-
5 level at the Japanese Language Academy (JLA)in my [Link] graduating from Japanese language school, I
would like to switch my career into IT field, so i would like to study Masters in IT Tourism in Japan,
because the fusion of Information Technology and tourism in Japan presents a unique and promising landscape,
both for travelers and those seeking job opportunities.
After that i would like to apply for a job specifically in tourism field in Japan using my improved language
skills.I am confident that studying in Japan will provide me with an unparalleled educational experience and
help me to achieve my career aspirations. I believe that this opportunity to study Japanese at Miyazaki
Information Business College will be a significant step towards fulfilling my dreams of academic and career
advancement in Japan. I am eager to begin this journey and make the most of this unique and exciting
opportunity.
以上の記載内容は事実と相違ありません。 志願者署名
I declare that all information in this form is Signature of
complete and correct Applicant 2025 年 05 月 15 日