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CICD SUMMER WORK & TRAVEL APPLICATION
Summer Work &
Travel Program International
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Center for International
Career Development

4530 Union Bay Pl NE,
Suite 214
Seattle, WA 98105
USA

Trainee/Intern Program:
(206) 985-2115

Work & Travel Program:
(206) 957-7112

International Programs:
(206) 985-2115

Fax: (206) 527-0338
cicd@cicdgo.com
  
CICD Summer Work & Travel Program Application

Please make sure that all information you enter into the registration form below is complete, and that the spelling is 100% accurate. Your name should be spelled exactly the same as it appears on your passport. The information from this registration information will be used to issue your official visa documents if your application is approved. Any errors can cause significant delays and additional expenses.

All fields marked * are required.

* Email Address of person filling
out this form:
* I am a:


1) Applicant Information
Please enter your personal information exactly as it appears in your passport.

* First Name:
Middle Name:
* Last/Family Name:
* Gender:
* Birth Date:
month:
day:
year:19
* City of Birth:
* Country of Birth:
* Permanent Residence:
* Country of Citizenship:
* Passport Number:
* Passport Expiration Date:
month:
day:
year:20
* Summer Vacation Start Date:
month:
day:
year:20
* Summer Vacation End Date:
month:
day:
year:20
SWT Program Start Date:
month:
day:
year:20
SWT Program End Date:
month:
day:
year:20
* How did you hear about CICD?


Please enter your permanent contact information. This is usually your home
country residence information.

* Street Address:
Street Address:
* City:
* Postal Code:
* Country:
* Email Address:
* Telephone Number:


If you currently live in the USA, please enter your current contact information
below. If you do not live in the USA, please skip to: 2) University Information

Street Address:
Street Address:
City:
State:
Zip Code:
Telephone Number:


2) University Information
* University Name:
* Street Address:
Street Address:
* City:
* Postal Code:
* Country:


3) U.S. Host Company Information (for Agents and Self-Placed Students only)

Name of your prospective
U.S. Host Company:
Your SWT Position Title:

Please enter your prospective supervisor’s contact information at the U.S.
Host Company:

Last/Family Name:
First Name:
Title:
Street Address:
Street Address:
City:
State:
Zip Code:
Email Address:
Telephone Number:
Fax Number:


4) Agency Information
This section must be completed if a partner agency assists the applicant with
finding a U.S. Host Company, using CICD as the visa sponsor, or with any other
aspect of this application.

Name of Agency:


Agency Representative (AR) information:

AR Last/Family Name:
AR First Name:
AR Email Address:
AR Telephone Number:
AR Fax Number:

  submit


 

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© 2010 Center for International Career Development