• Name*

• e-mail address*

• e-mail address (retype) *

• Phone number

• Country/place you are located*

• Native language* (second language)

• Occupation

• Gender

  MaleFemale

• Age*

  Below the age of 1616 or older

• Questions

About Japanese lessons

• Have you ever studied Japanese？*

  YesNo

(If you answered “Yes”) What is your level?*

BeginnerHigh beginnerIntermediateHigh-intermediateAdvanced

• You can read（Multiple choices allowed）

  HiraganaKatakanaKanjiNone

  Hiragana

  %

  Katakana

  %

  Kanji

  letters

• Passed JLPT (if any)

  N5N4N3N2N1

• Objectives to study Japanese, your goal*

• What you want to focus（Multiple choices allowed）

  SpeakingListeningReadingWritingGrammarVocabularyOther

• Preferred day and time for the 15-min. online interview (Japan time)

  Schedule 1：

  Month

  Day

  Anytime betweenand

  (Japan time)

  Schedule 2：

  Month

  Day

  Anytime betweenand

  (Japan time)

• How did you find Japanese Lunch

  Internet browserFacebookInstagramYoutubeFriends

• Do you mind if we send you a mail for information such as new course, events, etc.?

  NoYes

＊Please note that all fields followed by an asterisk must be filled in.