EMC Application Form
Please complete all sections below.
All fields marked with * must be completed.
I) Student Information
Student information
Full name *
Date of birth *
Gender *
Select
Male
Female
Age *
Passport number *
Student email *
Contact details information
Parent’s name
Home phone #
Cell phone #
Current address
Nationality
Language(s) spoken at home
II) Educational Background
Current school information
School name *
Start date *
Finish date *
Completed? *
Yes
No
III) EMC Program
Program Category *
-- Select --
OSSD Program
EMC Camp
Program *
-- Select --
Package A ($14,950)
Package A+ ($19,950 - including 100 hours of IELTS preparation)
Intake *
-- Select --
September
November
January
April
Year *
Session *
-- Select --
Summer Camp
Winter Camp
Year *
IV) Emergency Contact Information
Full name
Relationship to student
Phone number
V) Additional Services
Custodianship requested? *
Yes
No
Duration *
6 months
12 months
Homestay requested? *
Yes
No
Room type *
Single room
Twin room
Duration *
6 months
12 months
Airport pick up? *
Yes
No
VI) Agent Contact Information
Agent name
Agent email
Agent phone number
Submit Application
