BVI-BAVIC International Exchange Program Application
1. Personal Information
Surname
Given Name
Middle Name
Date of Birth
Sex
Select sex...
Male
Female
Marital Status
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Single
Married
Divorced
Widowed
2. Address & Contact Information
Home Address
State
Email
Primary Phone
Secondary Phone
3. Passport Information
Passport Number
Issuing Country
Passport Type
Select type...
Regular
Diplomatic
Official
Issue Date
Expiry Date
Passport Photo
Drag & Drop Passport Photo
or
Choose File
Supported formats: JPG, PNG, GIF (Max size: 2MB)
Please upload a passport photo
4. Previous U.S. Travel Information
Been to U.S.
Select...
Yes
No
U.S. Visa Issued
Select...
Yes
No
U.S. Visa Lost/Stolen
Select...
Yes
No
5. Security & Background
Communicable Disease
Select...
Yes
No
Mental/Physical Disorder
Select...
Yes
No
Drug Abuse
Select...
Yes
No
6. Present Work/Education
Employer Name
Education Level
Select level...
High School
Bachelor's Degree
Master's Degree
PhD
Institution Name
Course of Study
7. Declaration
I declare that all the information provided in this application is true and correct to the best of my knowledge.
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