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Please note fields marked with * are compulsory.

Full name: *
As in Passport/IC
Family name: *
Nationality: *
City of birth: *
Date of birth: *
Gender: *
Do you have an international passport? *
Have you ever lost a passport or have one stolen? *
Contact Number: *
Email Address: *
Please make sure mailbox is not full
Current Address: *
Postcode: *
Country: *
Name of university you are currently attending *
Campus location *
Course of study *
Month and year you started the course *
Month and year your course is scheduled to complete *
Have you ever been to the USA? *
When do you plan to participate in the program? *
How long do you plan to work for? *
Are you travelling with friends?
If yes, what are their names?
Please enter code as shown on the left: