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 PRC Other: *Alternative E-mail:   QQ Number:
    *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:  
    *Current Year of Study:       *Program Length (years):      *Year of Graduation: MM/ YY  
    *Will you be a full-time post-secondary student at the time you leave for the Program? Yes No  
    *Will you be a full-time post-secondary student when you return to your country of residence? Yes No  
     Language Proficiency
    *English: Fair Good Fluent N/A
    *Mandarin: Fair Good Fluent N/A
    *Cantonese: Fair Good Fluent N/A
     Other: Fair Good Fluent N/A
     Other: Fair Good Fluent N/A
     Other: Fair Good Fluent N/A
     Other Visa Information
    * Have you ever visited US? Yes No
    * Have you ever worked in US? Yes No
    * Have you ever received a J-1 visa to enter the USA? Yes No
    * Have you ever applied for a visa to immigrate permanently to the USA? Yes No
    * Have you ever been arrested or convicted of a crime? Yes No
    * Have you ever been refused a visa by a US Embassy / Consulate? Yes No
    If you answered "Yes" to any of these questions, please submit explanatory documentation by mail, e.g. a copy of your previous visa, DS-2019 form, documents from the Consulate or US State Department, etc.
     Full-Time/Part-Time Employment History
     If you don't have any work experiences, please provide any school / volunteer activities that you have participated in.
    *Company Name: *Country:
    *City: *Employment Date From:
    / DD / MM / YYYY Pick a date. t Use this to enter.
    *Job Title: *Employment Date To:
    / DD / MM / YYYY Pick a date. t Use this to enter.
    *Job Duties:  
     Company Name:  Country:
     City:  Employment Date From:
    / DD / MM / YYYY Pick a date. t Use this to enter.
     Job Title:  Employment Date To:
    / DD / MM / YYYY Pick a date. t Use this to enter.
     Job Duties:  
     Company Name:  Country:
     City:  Employment Date From:
    / DD / MM / YYYY Pick a date. t Use this to enter.
     Job Title:  Employment Date To:
    / DD / MM / YYYY Pick a date. t Use this to enter.
     Job Duties:  
     How did you find out about the program?
    * Internet Friends / Relatives School / University Other:  
     Nominator (applicable to Hong Kong / Macau applicants only):
     Please click here for specific terms and conditions.
     Full Name:  
     Identity Card No. (first 6 characters only - e.g. A12345):  
     Year of Participation:
     Buddy Campaign (applicable to Hong Kong / Macau applicants only):
     Please provide the full name of your Buddy(s), as appeared on his ID card, and also the first 6 digits of his ID number including any letter.
     Full Name:  ID No.: (e.g. A12345 if the number is A123456(7))
     Full Name:  ID No.:
     Full Name:  ID No.:
     Miscellaneous Information
     Hobbies:  
    * Can you swim? Yes No
    * Do you have an international driver's license? Yes No
    * Do you have a driver's license in your home country? Yes No
    * Computer Skills: Beginner Intermediate Advanced Expert
     Personal Statement
    *In no more than 100 words, please describe your personality, principle interest and activities and your preference in relation to your work placement. Please also state your reasons for applying for this exchange program.
    *In no more than 150 words, please explain "Why would I make a good employee for Work and Travel job?"
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