Program Application
Work and Travel USA Application Form

 Please pay the Non-refundable Administration Fee of HK$100.00 for students studying in Hong Kong and Macau, RMB$100 for students studying in Mainland China
  • 1. By check (please make check payable to "Intrinsic - for students and youth"
  • 2. By payment transfer (please transfer the payment to the following account and attach a receipt copy with your name written at the back)
              Hong Kong Participants: Hong Kong HSBC A/C (636-379232-838) Account Name: Intrinsic Ltd
              Macau Participants: Macau HSBC A/C (001-310929-095) Account name: Dang Hue
              Mainland China participants: Bank of China, Shekou, Nanyou Branch﹝中國銀行,蛇口, 南油支行﹞ A/C (4766913-0188-114005-1) Account name: 鄧華
    		•
     Personal Details - Please fill in all the information in English (except 中名姓名)
    *Family Name: *Given Name:
     Preferred Name:  中文姓名:
    *Date of Birth: / DD / MM / YYYY Pick a date. t Use this to enter. *Gender:   Male   Female
    *Identity Card No. (e.g. A123456(7)): *E-mail:
    *Passport Type: HKSAR BNO Other: *Alternative E-mail:
    *Passport No.: *Country of Birth:
    *Passport Expiry Date: / DD / MM / YYYY Pick a date. t Use this to enter.
     valid for 6 months beyond return date    		 *City/Province of Birth (City/Province shown in Passport):
    *Phone No.: ()-()-()
                       (Country code)-(Area code)-(Tel. no.)
    e.g. H.K. Tel. no. (852)-()-(12345678) / Guangzhou Tel. no. (86)-(20)-(23456789)    		 *Country of Citizenship:
    *Mobile No.: ()-()-() *Country of Legal Residence:
    *Address:  
    *City:
     Postal Code:  
    *Country:
    *Are you willing to disclose your E-mail to other students who will go to the same destination and work for the same employer? Yes No  
     Emergency Contact Information (Please provide your NEXT OF KIN information only)
    *Family Name: *Given Name:
    *Relationship to Participant:  E-mail:
    *Phone No.: ()-()-() *Mobile No.: ()-()-()
    *Address: *City:
     Postal Code: *Country:
     Education
    *Institution Name:  
    *Institution Location:
    *Major of Study: