Inquiry Form for Kurume University(Medical department)
This is the English Inquiry form at Kurume University(Medical department)
Please wait for a couple of days after you comment on this form.
If you are in a hurry, please call us directly.

For students who want to come to do the our clinical clerkship, at first, you need to apply this form and take the interview.
Joining in the interview  means the "application" for clinical clerkship, after we decide on acceptance, please do not withdraw the "application". 

1)Clinical Clerkship must be within 4 weeks. We can not accept any students over 4 weeks.

2)We only accept the ECFMG-eligible medical school.

3) We can issue the acceptance letter after the medical conference per month. 

4）Complimentaly for clinical clerkship

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Email *
①Last Name First Name　e.g.）Kurume Hanako *
②Email address *
③Email address（again, same as ②) *
④Your University name
(Only ECFMG-eligible medical school)
 *
⑤Title　e.g)Clinical Clerkship *
⑥Which medical department do you want to come？ （Except for Psychiatry medicine）
e.g)①Nephrology　②Orthopedics　③Pediatric surgery　④Diabetes internal medicine　　　　　　　　　　　　　　　Please write details ↓
×Internal Medicine→○Diabetes internal medicine
×Cardiology→○Cardiovascular Internal Medicine,Cardiovascular Surgery
○All surgery is ok
 *
⑦Scheduled start and end dates  　e.g)2023.7.1-2023.7.14 *
⑧What grade are you in ？　Which department(faculty,major) are you in?e.g)sophomore,medical department 
⑨Is it a IFMSA or JIMSA program?e.g)Yes, it is IFMSA'S program. (※MOU　 relation is not a IFMSA, please check this URL https://ifmsa.org/) *
⑩Even if you apply on this application, there are possibilities to be denied because of the over capacity. If we have no problems about the capacity, you have the interview in English.After you pass it, you have to submit the Immunization form(Kurume University designated one) and X-ray picture. *
⑪Do you want us to book the domitory,Galenus）http://galenus-kurume.com/galenus/？(JPY4200~4800 including 2 meals/ per day )If so,when do you wanna check in and checkout？When there are no vacancies, you have to book the hotel in Kurume by  yourself. *
⑫You have to pay clinical clerkship insurance   JPY1320　by cash at the medical department counter at the first time of program. *
⑬Do you need the religious consideration during the clinical clerkship?If so, there are possibilities to accept all your equest. e,g)have to wear hijab *
⑭Do you have to issue Japanese Visa to come to Japan？（https://www.mofa.go.jp/mofaj/toko/visa/nagare/tanki.html） *
⑮If you are not a robot, please write  "KURUME" below. *
⑯Nationality *
⑰Biometric Gender *
⑱Any additional comment?
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