Intercambio con una escuela de inglés en Hawaii | Central Pacific College

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Student Information Form

*If you are applying for the Spring/Summer Kids Program "Club Keiki", please use this link .

【Student Information】

Name

First Name *

Middle Name

Last Name *

Gender *

Male

Female

Date of birth *

Country of Citizenship *

Country of Birth *

Home Country Address *

Zip Code *

Phone *

E-mail: *

【Emergency contact】

Name *

Relationship *

Phone *

【Hawaii Address & Phone (If known) 】

Address *

Phone *

【PROGRAM INFORMATION】

Enrollment Dates *

※If you don't know the program start date, please refer to this page.

English Program *

EPP (English Proficiency Program) - 20 hours/week

STEP (Short-Term English Program) - 16 hours/week

Conversation Program - 18 hours/week

TOEIC (Test of English for International Communication)

TOEFL (Test of English as a Foreign Language)

Length of study (weeks) *

*Orientation sessions and placement tests will be offered at 1:30PM on your first day(Monday).You cannot attend classes on this day.

【OTHER INFORMATION】

*If you need housing, submit the following application form to info@ssahi.com

Accommodation *

Homestay

Condominium Residence(Shared Condo)

I will have my own accommodations.

Transportation (Optional) *

One way

Round

I will arrange my own transportation.

Payment (Registration) *

Credit Card (A processing fee of 4% will be charged for any transaction.)

Wire Transfer (additional $35)

Personal Checks

Already paid online

Payment (Tuition) *

Cash

Credit Card (A processing fee of 4% will be charged for any transaction.)

Wire Transfer (additional $35)

Personal Checks

Are you transferring from another school? *

Yes

Please write the name of your current school:

Please write your final date of attendance at that school:

Are you registering through an authorized CPC agent? *

Yes

If yes, please fill out the following

Name of Agent:

Location:

How did you learn about CPC? *

An Agent

Friend

Internet

Other

Name

PROMO CODE

Do you need an I-20? *

Yes

Please refer to this page for more information regarding eligibility for an I-20.
If Yes,

Number of Dependents

Name of dependent 1

Country of Citizenship

Country of Birth

Name of dependent 2

Country of Citizenship

Country of Birth

Registration fee : STEP/Club Keiki $100 or EPP $150 (non-refundable) *
Express I-20 mailing fee: EPP $100 (non-refundable) *
Textbook fee (2 textbooks): New ($120) *

I have read and understood that this is a pre-enrollment application, that I must request a refund if I cancel my enrollment(and that certain fees are non-refundable, as noted), and that my enrollment will not be completed until I obtain a visa (if required) and submit an enrollment agreement in person at CPC. *

Prior to submitting my payment, I have read and understand the refund/cancellation policy

CPC Introduction

Kids Program "Club Keiki"

Location

Central Pacific College

1221 Kapiolani Blvd. Suite 740
Honolulu, HI 96814

Tel: (808) 791-7800

Office hour: Mon-Fri 8:30am-5:00pm

Email: info@cpchawaii.edu

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1221 Kapiolani Blvd. Suite 740 Honolulu, HI 96814
Tel: (808) 791-7800
Fax: (808) 791-7804
Office hour: Mon-Fri 8:30am-5:00pm
Email: info@cpchawaii.edu

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