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Step 1 Program Choice:
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Country..........................
Dates........................... Australian Departure
City........................
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Program...........................................
Optional Program.......................................................
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Step 2 Background Information:
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First name........................
Middle name................................ Surname................................
(as it is shown in your passport)
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Sex...............
Date of Birth...................................... Age......................
School Year............
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Type of passport: Australian
or Other....................................................................................
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Parent(s) with
whom you live: Surname............................. First name(s)..............................
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Street Address....................................................................................................................
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Suburb..................................................
State...........................Postcode...........................
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Postal Address
(if different)..................................................................................................
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Suburb...................................................State...........................Postcode...........................
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Tel:(hm)..........................
Fax:(hm)........................ Student’s Email.....................................
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Father’s occupation..............................................
Tel:(wk):( )..........................................
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Mother’s occupation.............................................
Tel:(wk):( )..........................................
(If business
owners or company director, please provide specific field)
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Mother’s Email..........................................
Father’s Email..................................................
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Birth date(s) of
brothers.......................................................................................................
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Birth date(s) of
sisters.........................................................................................................
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Years of language
study (including present school year): Language........................Years.......
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Have you been abroad
before? No......Yes...... Country.....................................Year..............
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If you are invited
abroad by a specific family, please indicate name.........................................
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Address..............................................................................................................................
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City............................................ Postcode..................Tel:(
)........................................
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How did you learn
about our program?.................................................................................
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Would you like
to host? Yes....... No........
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If yes, what months
can you host? .....................................................................................
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Do you wish to
apply for a Nacel scholarship through hosting? Yes.......
No........
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Step 3. References:
(Referee signatures not necessary on this form)
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Language teacher
name.............................................. Tel:( ).........................................
(form
teacher if foreign language not required)
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School...............................................................................................................................
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Address..............................................................................................................................
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Suburb...................................................State...........................Postcode...........................
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Family friend...........................................................
Tel:( ).............................................
(not
a relative)
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Address.............................................................................................................................
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Suburb...................................................State...........................Postcode...........................
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Signatures:
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We have read and
understand the description of the program as well as the explanation
of the
costs, application and payment procedures and cancellation policy.
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Student signature.................................................................Date......................................
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Parent signature.................................................................. Date......................................
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PLEASE PRINT
THIS FORM, COMPLETE AND SEND WITH A DEPOSIT OF $50.00
To: Nacel Australia, 5/55 Hampden Road, Nedlands WA 6009
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What
Is Nacel's Payment
And Cancellation Policy ?
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How
To Pay ?
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