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[individual] Request for recruitment of students essential point form

When a recruitment of students essential point, an entrance to school application is requested, please fill in the item of the following forms.
I would like input by all means in all items.
Address ※required
 
Phone number ※required
Child, student name ※required
School name ※required

※An example: 0 0 ritsu 0 0 Elementary School 0 student
   * 0 ritsu 0 0 Junior High School 0 student
Offer essential point [junior high school]
(Half-width number)
Part
Offer essential point [high school]
(Half-width number)
Part
Institute of educational foundation Fukuyama Akenohoshi
〒721-8545
3-4-1, Nishifukatsucho, Fukuyama-shi, Hiroshima
TEL.084-922-1682 (academy direct)
FAX.084-925-1533 (academy direct)
※ About the individual inquiry
I would like it at the following.

(junior high school, high school)
TEL.084-922-1682
(elementary school)
TEL.084-923-5264
(kindergarten)
TEL.084-923-4244
(nursery school)
         TEL.084-982-6815
 
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