HIC English Program Enrollment Form Non-US Resident Only
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FIrst Name *
Family Name *
Date of Birth *
MM
/
DD
/
YYYY
Address *
Country *
Telephone Number *
Email *
Gender *
Race *
Language *
Highest Level of Education Completed *
Employment Status *
Required
Program of Interest *
Required
What is your goal (check all that apply)? *
Required
Have you taken an online class before? *
(Select all that apply) I have access to a: *
Required
I can attend class during the morning on the following days: *
Required
I can attend class during the afternoon on the following days: *
Required
I can attend class during the evening on the following days: *
Required
If you were referred by a school, please provide the name.
If you were referred by an NGO, please provide the name.
If you were referred by an agency, please provide the name.
Terms & Conditions / Privacy Notice (Click the link to view the terms and conditions) *
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