ࡱ> ` Rbjbjss   4XXXhYYdZZL[[[)^)^)^kmmmmmm$lhԄN )^])^)^)^[[yfff)^nR[ [kf;)^kffv" [x[Z 0 Xc7w?y,40dKw"d`"([x" [x)^)^f)^)^)^)^)^fj)^)^)^d)^)^)^)^D$::@4t" SjuSExaminee Registration Number ; [e_jL0eQ Filled by the host Institution   20080e,gRf0Syr%Rcn03uˊf The 2008 JLPT Request Form for Special Arrangements 1.3uˊe0Application date20080t^(Year)0000g(Month)0000e(Date)2.3uˊ Applicant TMR000W[ Name in capital Roman lettersut^ge0Date of birtht^(Year)0000g(Month)0000e(Date)SY00} Test Level}'`%R0Sex7uMale 0 sYFemaleSY00^ Test Site*NtNL03uˊY004XTo00 N0eQY00S0h0 *If a representative is applying on behalf of the applicant, please also fill in the boxes below.3.NtN Representative TMR Name@b^\HQ Affiliation3uˊh0n0O Relationship with applicant [n0.z^h0 z^k0Y00f Explanation of type and extent of disability (1)[n0.z^0Type of disability00S_f0o0~000n000000Y00 check appropriate box A. [ Visual disability[ ]hQvpW[Ye0SQ0f0D001_0+T0 Blindincludes persons with low vision /partial sight being educated in Braille [ ]1_0Low vision (partial sight)B. t[ Hearing disability00[ ]1Yt Complete hearing loss0[ ]t Partial hearing lossC. KR[ Physical disability[ ] N Upper limbs0[ ] N Lower limbs0[ ]]0n0N OtherD. LD/ADHDI{ LD/ADHD and other disabilities[ ]W[[ Dyslexia [ ]]0n0N Other00000000000000000000 (2) [n0 z^k0d0D0f00YuaY0y0M0pL0B00p0wQSOvk0fW0f0O0`0U0D0_g0B00p0%R}k0fD0f0mNY00S0h0 Please provide a detailed explanation of the disability, and any information you would like us to take into consideration. If necessary, please write on a separate sheet of paper.  NVn0Sg0 ^gY00yr%Rcn 2008 JLPT: Request for Special Arrangements in the 2008 JLPT ^gY00cnn0StPn0k00000W0f0O0`0U0D00 Please check the appropriate boxes on the right. 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