Brain Power Inc. | Visa Extension Helper

Nationality / Region

Date of Birth

Family Name

Given Name

Sex

Male

Female

Marital Status

Married

Single

Home Town/City

Address in Japan

Telephone No.

Cellular Phone No.

Passport Number

Passport Expiry Date

Current Status

Current Period of Stay

Date of Expiration

Residence Card Number

Desired Length of Extension

Criminal Record

No

Yes

Education (Last School Graduated)

Location of School

Japan

Foreign Country

Name of School

Highest Level of Education

Date of Graduation

Major Field of Study (for University/Jr. College)

Work History (including current)

Instructor-Specific Information

Teacher's Certificate

Yes

No

Teaching Experience (Years)

Years of English Education Received

Place of Work (Board of Education)

Select your main Board of Education

List of Schools You Work At

You must list at least one school you work at. Use Google Maps to find the address. If you don't know the phone number, please contact Brain Power.

Family in Japan & Co-habitants

I have family members or co-habitants in Japan.

Salary Information

Your Monthly Salary (before tax)

JPY

Your Contract Period (Months)

You're all set! Please review all your entered information carefully. When you are ready, click the button below to generate your completed visa application form.

Step 1: Personal Information

Step 2: Passport & Residence Status

Step 3: Education & Work History