The Japanese higher education has attempted various internationalization initiatives (e.g., the Top Global University Project), and adopted English-medium instruction (EMI) and English-taught programs (ETPs). Based on several criticisms toward the project and recent investigations of the international students' satisfaction, a lack of formal and structural support for international students has been identified. While a paternalistic approach of student support has been practiced and recognized, this approach relies on informal support of a handful hardworking staff/faculty members and student volunteers/tutors. Furthermore, there are several major issues in integration of EMI/ETPs and administrative infrastructure in internationalization initiatives. In order to make improvements in both activities, international students' adaptation to Japan and its higher education need to be fully considered. In this process of international students' adaptation to a new culture, lack of cultural awareness and intercultural communication, inadequate language skills, educational system differences, and life adjustment and psychological problems are identified as major concerns.