College Admissions Form

I.W.H.P
1 Kentwood Drive Robina 4228
ABN 39 318 806 836
englishstudy@iwhp.net
www.iwhp.net
+61 40 1050 985
Personal Infomation
Name*

First NameLast Name
Date of Birth *

DayMonthYear
Gender*

MaleFemale
E-mail Address*

Confirmation Emailexample@example.com 携帯電話のメールアドレスは避けてご利用ください。
Of which country are you a citizen?*
Telephone or Mobile Phone
Format: (000) 000-0000.
Passport No
すでにお持ちであればご記入ください。
Current English level

ElementalyPre-intermediateIntermediateAdvanced
Current Home Address*

Street Address

Street Address Line

CityState / Province

Postal / Zip Code
School information
Are you going to attend a school?

English study at IWHP Teacher's homeNoOther school
Commencement Date

DayMonthYear
学校開始日
End Date

DayMonthYear
学校終了日
Homestay information
Homestay check inDate

DayMonthYear
ホームステイ開始日
Check out Date

DayMonthYear
ホームステイ終了日
Please select your homestay type.*
Do you like the child(ren)?

YesNo
Do you mind if the host family speak with your language?

Yes（気にする）No（気にならない）
Do you smoke?

YesNo
Do you like pets?

YesNo特定の嫌いな動物
Do you have any medical conditions or do you take any prescription medication on a regular basis (excluding the pill)

NoIf yes, Please describe:
Do you have any allergies?

NoIf yes, Please describe:
Do you have any religion?

NoIf yes, Please describe:
What are your hobbies/interests?
Please attach your passport copy if you have

ファイル形式：pdf, jpg, jpeg, png, gif 最大１０MBまで
Cancelof
Flight information
If you know your flight details, please describe

I haven't got my flight ticket yet.Gold Coast AirportBrisbane airport
Flight ARRIVAL date

日月年
到着日
時分AM/PM Option
Flight number (eg: JQ12)
At least 12 weeks
Flight DEPATURE date

日月年
帰国日
時分AM/PM Option
Flight number (eg: JQ12)
At least 12 weeks
Would you like IWHP to arrange an airport shuttle bus service?

Yes 片道のみ　ブリスベン空港＄79〜　GC空港＄44〜Yes 往復　ブリスベン空港＄149　GC空港＄83No
Volunteer Program
Would you like IWHP to arrange volunteer program?

YesNo
Commencement Date

DayMonthYear
実習開始日
End Date

DayMonthYear
実習終了日
Participation Time
大体の参加時間をご記入ください。例）９：００−１５：００など
Requests, Notes if any
参加にあたり園にて配慮が必要なことはありますか?
Which class and what you want to try？
やってみたいこと、クラスの希望　※園の事情により、ご希望に添えない場合があります。
Terms and conditions
Agent company name
日本のエージェントを通された方はこちらに記載お願いします。
署名をお願いします。*
Should be Empty:

Personal Infomation

School information

Homestay information

Flight information

Volunteer Program

Terms and conditions