Application Form - Consulate General of Japan

2012 JAPANESE AMERICAN LEADERSHIP DELEGATION TO
JAPAN
12 TH ANNIVERSARY DELEGATION
APPLICATION FORM
Individuals selected must be able to travel to Japan from March 2 -
10, 2012 and
attend a mandatory orientation in Los Angeles on January 20 - 21,
2012.
Deadline for application submission: November 13, 2011.
Your resume may be used for the following information and can be
supplemented with an attachment. However, all requested
information must be provided.
Name
Address – Business and Home (specify preferred mailing address)
Telephone – Business, Home, Cell Phone
E-mail Address
Occupation
Date of Birth
Prefecture(s) in Japan where your ancestors originated
Educational Background (Specify name of university or institution,
degree, specify major, year of graduation, honors, etc.)
Professional Background (Current employment - Specify name of
company/organization, title, years of employment and other
relevant information; brief listing of prior employment).
Professional Affiliations & Leadership Positions
Community/Volunteer Affiliations & Leadership Positions
Prior Visits to Japan if applicable (Specify year, length of stay and
purpose of visit)
Personal Interests (Hobbies, cultural/social interests, etc.)
References (Two): (Preferably individuals who are knowledgeable
about your experience in U.S.-Japan relations and/or your
professional/community/volunteer experience).
Letters of recommendation are not required.
Please provide a brief response to the following questions:
Attach separate sheet – no more than TWO pages double-spaced.
1. Why do you wish to participate in this program?

2. Briefly describe any prior experience you have had in
U.S.-Japan relations.
3. How did you learn about this program?
Deadline for receipt of applications: November 13, 2011
Application should be submitted by email, fax, or mail to Yoshiro
Tasaka, Advisor for Community Affairs at Consulate General of
Japan in San Francisco (Fax: (415) 974-3660, email:
sa2cg@cgjsf.org). A duplicate copy should also be sent to Bryan
Takeda at US-Japan Council by email to
btakeda@usjapancouncil.org. Please note “Application for the
Japanese American Leadership Delegation” on the front of the
envelope if you mail the application. Successful first round
candidates will be invited to the Consulate office for an interview
scheduled between November 16 and November 23.
INFORMATION
Consul General of Japan in San Francisco
Yoshiro Tasaka, (415) 356-2441, sa2cg@cgjsf.org
Consulate General of Japan in Los Angeles
Ms. Jennifer Usyak, (213) 617-6700 x166,
j_usyak@la-cgjapan.org, or
Consul Toshio Odagiri, (213) 617-6700,
t_odagiri@la-cgjapan.org
U.S.-Japan Council
Mr. Bryan Takeda, Director of Programs, Los Angeles Office
btakeda@usjapancouncil.org, (626) 396-9927 or (310) 500-2872