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
