GO: Programs Application Form 2021–22 All fields must be completed. Please email completed form to usa.admissions@kingseducation.com I am applying for a place at (name of host college/university):
Student details Family name:
Given names:
Date of birth (dd/mm/yy):
City of birth:
Nationality:
Email: Male Country of birth:
Female
Home address (including country and postcode):
Where do you currently live?
Telephone (including country code)
Mailing address (if different from home address):
Parent/guardian details Family name:
First/given names:
Relationship to student:
Email: Male
Female
Home address (including country and postcode):
Home telephone:
Business telephone:
Mobile telephone:
Personal and medical information Please provide details of any medical conditions which require notification to Kings and/or require any prescribed medication.
If you are not a US citizen, or lawful permanent resident, and you already have a visa, please indicate the type.
Do you have a criminal record? (except traffic violation). If yes, please provide details.
Student insurance Insurance is mandatory for all students. If you are enrolled in GO Prepared, the cost of the student insurance will be automatically added to the Kings invoice. Once you commence the Degree Pathway, the host institution’s insurance cost is automatically added on the pathway invoice.
1 of 4