First Name *

Middle Name (if any)

Last Name *

Email Address *

Phone Number *

Fax number

Date Of Birth (mm/dd/yyyy) *

Country of Citizenship *

Country of Birth *

Gender *MaleFemale

Which month do you wish to begin studies?*JanuaryMarchMayAugustOctober

Which year do you wish to begin studies?*2017201820192020

Permanent Mailing Address*

Street *

City *

Country *

Postal Code *

Upload a copy of your government ID*

I will email it to hawcciep@hawaii.edu later. (Please note that your application process is not completed until we receive your documents).

Have you taken any of test below?TOEFLTOEICIELTSEIKENOtherNone

If you have, please let us know which test and your score.

Please let us know your English level*Pre-intermediateIntermediateHigh-intermediateAdvanced

Optional Services (Housing support - $50 one time non-refundable fee)YesNo

If yes, please choose from the following.1 Bedroom (not shared)2 Bedrooms (shared unit, 1 bedroom each)

If yes, how much can you afford to pay for rent each month.$500-$650$650-$800$800-$890

How did you find the Intensive English Program (IEP)?Agent (Please write the agent name in the text box below)By a friend (Please write your friend's name in the text box below)IEP websiteHawaii Community College websiteMo-hawaii.com websiteSearch engine (Google, Yahoo, Bing etc)The IEP brochureOther (Please write in the text box below)

For fee payments, we will contact you via email. Please note that your application process is not completed until we receive your payments.

Comment/Note