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Application Form

Please read the terms and conditions below and fill out your personal information.

 
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Personal Infomation * Optional
 First Name  Middle Name*  Last Name
 Sex Male Female
 Current Address
 City  State  Postal Code  Country
 Permanent Address*
 City*  State*  Postal Code*  Country*
 Phone No.
 E-Mail Address
 Date of Birth  Age  
 Passport No.
 Place of Birth*  Country of Residence*  Citizenship*
Emergency Contacts
1.  Name  Relationship  Phone No.
 
   Address  E-mail
 
2.  Name  Relationship  Phone No.
 
   Address  E-mail
 
Education Background
 University  Major
1st year 2nd year 3rd year 4th year Graduate Student
 
 Career

 What language do you speak?

 Do you have any physical disabilities?
No Yes

 Do you have any concern about your health?

No Yes
 Your Hobbies
 Comment or Request*
 
Terms & Conditions
  • Travel insurance during your stay will be given to you.
  • “Once a life” program will not be responsible for any loss of yours, overstaying, and breaking laws.
  • To cancel, you will receive a refund 50% of fee if you send an e-mail or a letter to us A MONTH BEFORE program starts. Any cancellation later than that will not be refunded.
  • Cancelation by Once a Life, participants who have paid the fees already will get a refund 100% of the fee.
  • We do not accept any cancellation by phone.
  • A certificate by Once a Life program will be given to you after you finish a program

I acknowledge that I thoroughly read all “Once a Life” program information, terms and conditions for my placement. I hereby agree on all the terms and conditions given by “Once a Life” program.

I understand everything that I have read, and I will fully abide by all of “Once a Life” program terms and conditions.

*To pay the fee, you will receive an e-mail with an invoice (Paypal) after you have submitted the application form. And, you can follow the instruction and pay the fee online.

 

 
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