Chanova Study Abroad Program Enrollment (High School)

Chanova Language & Life

Program Applicaton Form
Personal Information
Name (As in your passport)

First NameLast Name
Phone Number
Format: (000) 000-0000.
Nationality
Date of Birth

MonthDayYear
Date
Gender
Email (Essential updates will be sent to this email)
example@example.com
Alternative Email Adress
example@example.com
Do you have any medical conditions, or disabilities that could affect your ability to participate in the study abroad program? If so, please provide details and any necessary precautions that may be required to ensure your safety and well being while studying at our partner university abroad.
Please note that any medical information provided will be kept confidential and will only be shared with relevant staff members to ensure your safety and wellbeing during the study abroad program.

Program Details
Attending Program
Passport Issue Date

MonthDayYear
Date
Passport Valid Until

MonthDayYear
Date
Passport Number
Home Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home School Information
Level of Current Study
School Name
School Country
Your Current Year of Study

Contact Person/ Emergency Contact
Full Name of your contact person

First NameLast Name
Contact's E-mail
example@example.com
Contact's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to you
Contact's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Declaration and Consent
I hereby confirm that the information provided in this application is true, accurate, and complete to the best of my knowledge.

I understand that participation in the program may include academic activities, housing arrangements, local transportation, cultural programs, day trips, excursions, and other off-campus experiences. I acknowledge that travel and participation in such activities involve inherent risks, including but not limited to illness, injury, accidents, loss of personal property, travel delays, or other unforeseen circumstances.

I confirm that I am physically and mentally fit to participate in the program and that I will maintain appropriate health insurance and valid travel documents throughout the program period. I agree to comply with all program policies, safety guidelines, and local laws and regulations. I understand that failure to follow program rules or engaging in unsafe or inappropriate behavior may result in dismissal from the program without refund.

To the fullest extent permitted by law, I voluntarily assume all risks associated with my participation and agree to release and hold harmless the program organizers, their staff, partner institutions, accommodation providers, service partners, and affiliated organizations from any liability for injury, illness, loss, damage, delay, or expense arising from my participation, except in cases of gross negligence or willful misconduct.

I also understand that photographs or videos may be taken during program activities for educational, administrative, or promotional purposes, unless I notify the program in writing otherwise.

I acknowledge that the personal information collected in this application will be used solely for program administration, including application processing, enrollment management, academic coordination, housing arrangements, emergency contact, visa support, and program-related communication. I understand that my information may be shared with trusted partner institutions and service providers when necessary to support my participation. All personal data will be handled securely and will not be sold or used for unrelated purposes without my consent.

By submitting this form, I confirm that I have read, understood, and agree to the terms stated above.
Signature
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Chanova Language & Life

Personal Information

Program Details

Home School Information

Contact Person/ Emergency Contact