STEP1 Entry
Japanese

Donation Information

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

 Type of donation Fund of EVERGREEN -Kyushu University Faculty of Engineering Sciences
 Purpose of donation
＊Payment method
＊Amount of donation  yen   

Subscription Information

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＊Individual / Corporation
＊Name First name      Last name    
 Sex
＊Date of birth year   month   day  
＊Company name
 Name of representative First name      Last name    
＊Name of the person in charge First name      Last name    
＊E-mail address
 of the person in charge

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＊Address
＊City/State/ZIP
＊Country
 Phone number  (Do not include hyphens.)
＊E-mail address

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＊Relationship to university
 Student id number
 Student name
 Department
    Student grade year
 The year of graduation year
 Belonging
 General

Questionnaire

（１） Regarding the use of donations If you have any requests regarding the use of your donations, please describe in below.
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（２） Regarding the donation procedure If you have any comments or opinions about this donation procedure,please describe in below.We will read this carefully.Thank you.

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