Zapis online | BTC

BASIC DETAILS

Last name

First name

Middle name

Sex

MaleFemale

Male

Female

Date of birth

City of Birth

Nationality

CONTACT INFORMATION

Mobile phone

Skype

PERMANENT ADDRESS

Street and number

City

Country

Postal code

CORRESPONDENCE ADDRESS -----for important documents

sameother

same

other

Address (street and number)

City

Country

Postal code

EMERGENCY CONTACT

Relationship

Full name

Mobile phone

Address

Address (street and number)

City

Country

Postal code

STUDIES

Name of Institution

City

Field of study

Years of studies

Expected year of graduation

Mode of study

PASSPORT DETAILS

Passport number

Expiration date (must be min 6 months after program end date)

Country of issuance

Polandother

Poland

other

a) if not Poland, what country?

b) what kind of permit do you have?

c) expiration date (if document is not valid until end of program you must extend it before departure)

VISA INFO

Have you ever been in the United States?

yesno

yes

If yes, what purpose?

Have you ever been denied an American visa?

yesno

yes

Have you been arrested?

yesno

yes

WORK AND TRAVEL USA

Select WAT program option:

If option B- which job offer are you interested in?

Preferred work dates:

From

Who else will travel with you on the WAT program?

Flight ticket option (refer to program agreement)

How did you learn about our program?

PROMOTION CODE

Promo Code

ZAPIS ONLINE / REGISTRATION

Address

Country of issuance

Have you ever been in the United States?

Have you ever been denied an American visa?

Have you been arrested?

Preferred work dates:

How did you learn about our program?

Work & Travel USA

High School USA

Camp USA

Inne usługi

Centrala BTC