REGISTRATION FORM 20_____
Programme applying for: WAT USA_____ INT/PCT_____________
Surname_____________________________________
First Name____________________________________
Middle _____________________________________
Alias/tribe or Pet name_______________________________
Institution/school________________________________________ D.O.B ________________________ Sex
F___/___M_
Nationality
_______________________ Telephone _________________________(H)___________________________(C)
Permanent
Address___________________________________________________________________________________________________
____________________________________________________________________________________________________________
Contact
Person (must not 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
How did you know about Global/work and travel:_______________________________________________________
Will you be requiring job assistance/placement Yes/ No
Do you have independent placement Yes
/ No _________
(I
have read all the information in the terms and condition)
Sign ________________________________________ Date ________________________ Witness ____________________
Date ______________ (REGISTRATION FEE IS NON REFUNDABLE,NON TRANSFERABLE)
____________________________________________________________________________________________________________
This package is not negotiable FOR OFFICAL USE ONLY : _
ATTENDING INSTITUTION __________________________________________________________________________________
PRE-INTERVIEWED
BY __________________________ DATE _________________________
APPLICATION APPROVED BY______________________________________ DATE _____________________________
Pre interviewed Yes ( ) No ( )
