Japanese Language Placement Test Survey Form

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Full Name as on Matriculation Card.:
If you have other name(s) than the one on your matriculation card, write them in ( ) at the end. DO NOT CHANGE your name order on your matriculation card.
Matric Number
(Please indicate the alphabet)

1.Write your first/second/third language.

First language / Second language / Third language (if any)

2. Describe more details of your previous experience of learning Japanese:

Classroom instruction / When / Hours per week / How many weeks? / Hours in total
In a higher education institution including NUS, Polytechnics, Student Exchange Programme, Overseas Intensive Programmes, etc.
Name of the institution/module in NUS: / Name of the textbook(s) used: / MM/YY - MM/YY / hrs/week / weeks / hrs
MM/YY - MM/YY / hrs/week / weeks / hrs
MM/YY - MM/YY / hrs/week / weeks / hrs
MM/YY - MM/YY / hrs/week / weeks / hrs
MM/YY - MM/YY / hrs/week / weeks / hrs
In MOE Language Centre (GCE Japanese)
O Level / AO Level / A Level (Trace or Circle one) / MM/YY - MM/YY / hrs/week / weeks / hrs
In other school (private language school, secondary/primary school, etc.)
Name of the institution / Name of the textbook(s) used: / MM/YY - MM/YY / hrs/week / weeks / hrs
MM/YY - MM/YY / hrs/week / weeks / hrs
Total Number of instructional hours in classroom / hrs
Self-study/ Intensive Exposure to Japanese Language including online programmes, video, in-country experience, etc.
Mode of study/ Type of exposure: / Name of the material(s) used: / MM/YY - MM/YY / weeks/months/years
MM/YY - MM/YY / weeks/months/years
MM/YY - MM/YY / weeks/months/years

3.If you have taken Japanese Language Proficiency Test (JLPT), describe the highest level of JLPT you took.

Level:N5 (old level 4)/N4 (old level 3)/N3/N2 (old level 2)/N1 (old level 1) / When:: MM/YY / Result: Pass / Fail / Not known yet

4.If you have any family/relative(s) whose first language is Japanese, state the relationshipbetween you and the person(s).(E.g. Father).

5. State your reason for takingJapanese placement test.

□I declare that all the information and statements above are true and correct. ______

(Signature / Date)

NATIONAL UNIVERSITY OF SINGAPORE

FACULTY OF ARTS AND SOCIAL SCIENCES

CENTRE FOR LANGUAGE STUDIES

Placement Test Declaration Form – Japanese Language

Language/ Module Taken for Placement Test: / Date of Test
  1. Student Particulars

Full Name: / Major:
Matric No. / Year of Study: / Email:
Faculty: / Contact No.:
  1. Records of study for language taken in schools, universities (including NUS) or any other educational institutions:

S/N / Schools/Institutions/Country: / Duration of Study / Grade obtained in NUS/Certification(s) Obtained: e.g. ‘O’, ‘AO’, JLPT etc. / Year Obtained:
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2
3

*Please use separate sheet if necessary.

  1. Records of study of this language outside educational institutions (self-study, study with friends, etc)

Please describe how, when and how long you studied this language outside educational institutions:

______

______

*Please use separate sheet if necessary.

  1. Mapping Records for Language Modules Taken at PartnerUniversity (if any)

S/N / PartnerUniversity: / Language Modules taken at Partner University / Semester/ Year of Study: / Grades Obtained:
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2
  1. Records of Past Placement Test Taken in NUS (if any)

S/N / Language Taken / Semester, Academic Year taken : / Pass/Fail / Module Placed In
1
2
  1. Stay in country of the target language (if applicable)

S/N / Country / Period / Duration
1
2
Signature / Date

I declare that the above information given is true.

  1. For Official Use

Module Recommended:
Approved by :
Name / Signature / Date
Comments/Remarks:

______

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