REGISTRATION FORM 20____
Programme applying for: WAT
USA_
INT/PCT
Please
answer all question marked with an asterisk.
*Surname
*First Name_
*middle
Institution/school
*D.O.B
Sex
Nationality
*Telephone
(H)
(C)
*Permanent Address
*Contact Person (must not be a participant of
the programme or share your address &
Telephone)
*Relationship to applicant
*Student status
Full or
Part time_
Length of Course
Year of Study
Course of Study
Professional
Certification /Training(INT/PCT)*for graduates Term Address
*Email address
Have ever been issued a J1 Visa Y /
N_____________
If Yes where did you work and what City/State______________________________________________________ ______________________________________________________________
How did you know about us/work
and travel:
Will you be requiring job assistance/placement
Yes/ No
(If
YES please fill in Job Agreement Bond) Do you
have independent placement Yes / No
(If YES Employment
Agreement Form must be submitted to Global Insight by March 15th).
(I have read all the information in the e-brochure and the terms and conditions)
Sign
Date
Witness Date ____________
(REGISTRATION
FEE IS NON REFUNDABLE,NON TRANSFERABLE)
This package
is not negotiable FOR OFFICAL USE ONLY : _ ATTENDING INSTITUTION
PRE-INTERVIEW BY
DATE
APPLICATION
APPROVED BY
____________ DATE_____________________
