Registration - First Class Cultural Travel Experience

1PROFILE TYPE

2BASIC INFORMATION

3EDUCATION

4J1 HISTORY

5VISA DENIAL

6MEDICAL HISTORY

7PROGRAM FUNDING

8CONSENT

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Name*

First Middle Last

Gender*

Male

Female

Date of Birth*

DD slash MM slash YYYY

Parish of Birth*

Place of birth (outside Jamaica)*

Enter the country/province/state in which you were born

Nationality*

Desired Job Type*

Greencard holder?

Yes

Cell Number*

Is this a WhatsApp number?*

Yes

Cell Number (additional)

Is this a WhatsApp number?*

Yes

Your Email Address*

Your T.R.N*

Tax Registration Number

Your S.S.N

Social Security Number This is issued by the US government and typically only persons who have worked in the USA before would have one.

Your Permanent Address*

Street Address City

Have you ever been convicted of a crime?*

Yes

Are you a full time student?*

Yes

Name of Institution*

Please select your school from the list

Program of study*

Are you registered for the current semester?*

Yes

Total credits taken in fall semester*

"Fall semester" is September to December

Total credits taken in spring semester (or intend to take)*

"Spring semester" is January to May

Programme type:*

Doctorate (PhD)

Master's Degree

Bachelor's Degree

Associate Degree

Diploma

Certificate

Program start date*

When did you start your university program?

DD slash MM slash YYYY

Expected completion date*

When will you complete university? (Best estimate)

DD slash MM slash YYYY

Unfortunately, only currently registered students are able to participate in the Cultural Work and Travel programme. You will NOT be able to submit this form.
We're sad you won't be with us this year but look forward to you joing us for Cultural Work and Travel as soon as you resume your studies!

Have you ever participated in the J1 Work and Travel program?*

Yes

How many times?*

Please provide most recent*

To add a new row, select the "+" icon to the right.

Employer

Position(s)

Sponsor(s)

Year(s)

Have you ever been terminated from any J1 job?*

Yes

Reason for termination*

How did you hear about this agency?

Example: Instagram, School Expo, Your Friends Name etc.

Have you ever been denied a US visa?*

Yes

Indicate type*

H2B

B1/B2

Other

Do you have any medical conditions that might affect the performance of your duties?*

Yes

List any applicable conditions here*

Put each condition in its own row. To add a new row, select the "+" icon to the right

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PROGRAM FUNDING

Who will be funding your program?*

To add more than one source of funding, select the "+" icon to the right

Name

Cell Number

Cell Number (other)

Email Address

Local emergency contact*

Name

Relation

Cell Number

Cell Number (other)

Email Address

USA emergency contact

Name

Relation

Cell Number

Cell Number (other)

Email Address

Address

By entering the required information below, I declare that the information provided is true and correct to the best of my knowledge. I understand that any willful dishonesty may result in rejection of your application.

I agree to the statement above.

Your Signature*

Please use you finger, stylus or mouse to apply your signature to the line below. This uniquely identifies you, notes your intent and is legally binding.

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Name*

First

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Passport Number*

Comments

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