{"id":35092,"date":"2023-12-16T00:46:28","date_gmt":"2023-12-15T16:46:28","guid":{"rendered":"https:\/\/merlionacademy.sg\/cn\/?page_id=35092"},"modified":"2024-05-13T12:40:45","modified_gmt":"2024-05-13T04:40:45","slug":"application","status":"publish","type":"page","link":"https:\/\/merlionacademy.sg\/cn\/application\/","title":{"rendered":"Apply"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"35092\" class=\"elementor elementor-35092\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d65d94c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d65d94c\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e7b8197\" data-id=\"e7b8197\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-044d2e2 elementor-widget elementor-widget-image\" data-id=\"044d2e2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/merlionacademy.sg\/\">\n\t\t\t\t\t\t\t<img decoding=\"async\" src=\"https:\/\/merlionacademy.sg\/cn\/wp-content\/uploads\/elementor\/thumbs\/Logo-MerlionAcademy-PNG-no-background-qguux3ddpy5xetcxbs5267iknqo2mnssene08dxqwk.png\" title=\"Logo MerlionAcademy (PNG) no background\" alt=\"Logo MerlionAcademy (PNG) no background\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-67a3684 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"67a3684\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b9c0bfb\" data-id=\"b9c0bfb\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-03cefdb elementor-widget elementor-widget-spacer\" data-id=\"03cefdb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3e1a00a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3e1a00a\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-507076e\" data-id=\"507076e\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3811fa6 elementor-widget elementor-widget-text-editor\" data-id=\"3811fa6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"color: #000000;\">Thank you for your interest in our program. Please complete the form below and pay a<\/span><span style=\"color: #000000;\">n administrative fee of\u00a0<strong>SGD95\/-<\/strong> to process your application.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f806f09 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f806f09\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d6b5d64\" data-id=\"d6b5d64\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3343c5a elementor-widget elementor-widget-heading\" data-id=\"3343c5a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Application Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9a9c6d5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9a9c6d5\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-657812b\" data-id=\"657812b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cee764c elementor-widget elementor-widget-wpforms\" data-id=\"cee764c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-35063\"><form id=\"wpforms-form-35063\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"35063\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/cn\/wp-json\/wp\/v2\/pages\/35092?wpforms_form_id=35063\" data-token=\"41184f3953cf7e353e6fc200acda7992\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-35063-field_1-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"1\"><div id=\"wpforms-35063-field_1\"><div style=\"background-color:#002060; width:100%; padding:5px;\"> <div style=font-size:110%;padding-left:5px;><h1 style=color:white>Personal Information<\/h1><\/div>\r\n<\/div><\/div><\/div><div id=\"wpforms-35063-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_2\">Name as in passport <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-35063-field_2\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][2]\" required><\/div><div id=\"wpforms-35063-field_70-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_70\">Upload your passport sized photo <span class=\"wpforms-required-label\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"70\"\n\t\tdata-form-id=\"35063\"\n\t\tdata-input-name=\"wpforms_35063_70\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages,json\"\n\t\tdata-max-size=\"268435456\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"268435456\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"#b1b1b1\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag a file to this area to upload.<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-35063-field_70\"\n\t\tname=\"wpforms_35063_70\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-35063-field_5-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"5\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-35063-field_5\">gender<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_3\">Chinese name (if applicable)<\/label><input type=\"text\" id=\"wpforms-35063-field_3\" class=\"wpforms-field-large\" name=\"wpforms[fields][3]\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_6-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_6\">Gender <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-35063-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required=\"required\"><option value=\"Select\" >Select<\/option><option value=\"Male\" >Male<\/option><option value=\"Female\" >Female<\/option><\/select><\/div><\/div><\/div><\/div><div id=\"wpforms-35063-field_7-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"7\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-35063-field_7\">Birth<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_73-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_73\">Country of birth  <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-35063-field_73\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][73]\" required=\"required\"><option value=\"Select\" >Select<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia (Plurinational State of)\" >Bolivia (Plurinational State of)<\/option><option value=\"Bonaire, Saint Eustatius and Saba\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cabo Verde\" >Cabo Verde<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos (Keeling) Islands\" >Cocos (Keeling) Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo\" >Congo<\/option><option value=\"Congo (Democratic Republic of the)\" >Congo (Democratic Republic of the)<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"C\u00f4te d&#039;Ivoire\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Kingdom of)\" >Eswatini (Kingdom of)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands (Malvinas)\" >Falkland Islands (Malvinas)<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard Island and McDonald Islands\" >Heard Island and McDonald Islands<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran (Islamic Republic of)\" >Iran (Islamic Republic of)<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland (Republic of)\" >Ireland (Republic of)<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Korea (Democratic People&#039;s Republic of)\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"Korea (Republic of)\" >Korea (Republic of)<\/option><option value=\"Kosovo\" >Kosovo<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People&#039;s Democratic Republic\" >Lao People&#039;s Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macao\" >Macao<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia (Federated States of)\" >Micronesia (Federated States of)<\/option><option value=\"Moldova (Republic of)\" >Moldova (Republic of)<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Macedonia (Republic of)\" >North Macedonia (Republic of)<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine (State of)\" >Palestine (State of)<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russian Federation\" >Russian Federation<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena, Ascension and Tristan da Cunha\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin (French part)\" >Saint Martin (French part)<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten (Dutch part)\" >Sint Maarten (Dutch part)<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia and the South Sandwich Islands\" >South Georgia and the South Sandwich Islands<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen\" >Svalbard and Jan Mayen<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syrian Arab Republic\" >Syrian Arab Republic<\/option><option value=\"Taiwan, Republic of China\" >Taiwan, Republic of China<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania (United Republic of)\" >Tanzania (United Republic of)<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"T\u00fcrkiye\" >T\u00fcrkiye<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom of Great Britain and Northern Ireland\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"United States Minor Outlying Islands\" >United States Minor Outlying Islands<\/option><option value=\"United States of America\" >United States of America<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Vatican City State\" >Vatican City State<\/option><option value=\"Venezuela (Bolivarian Republic of)\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands (British)\" >Virgin Islands (British)<\/option><option value=\"Virgin Islands (U.S.)\" >Virgin Islands (U.S.)<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_10-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_10\">Race <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-35063-field_10\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][10]\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-35063-field_11-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"11\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-35063-field_11\">Nationality<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_74-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_74\">Nationality <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-35063-field_74\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][74]\" required=\"required\"><option value=\"Select Option\" >Select Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia (Plurinational State of)\" >Bolivia (Plurinational State of)<\/option><option value=\"Bonaire, Saint Eustatius and Saba\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cabo Verde\" >Cabo Verde<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos (Keeling) Islands\" >Cocos (Keeling) Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo\" >Congo<\/option><option value=\"Congo (Democratic Republic of the)\" >Congo (Democratic Republic of the)<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"C\u00f4te d&#039;Ivoire\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Kingdom of)\" >Eswatini (Kingdom of)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands (Malvinas)\" >Falkland Islands (Malvinas)<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard Island and McDonald Islands\" >Heard Island and McDonald Islands<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran (Islamic Republic of)\" >Iran (Islamic Republic of)<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland (Republic of)\" >Ireland (Republic of)<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Korea (Democratic People&#039;s Republic of)\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"Korea (Republic of)\" >Korea (Republic of)<\/option><option value=\"Kosovo\" >Kosovo<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People&#039;s Democratic Republic\" >Lao People&#039;s Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macao\" >Macao<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia (Federated States of)\" >Micronesia (Federated States of)<\/option><option value=\"Moldova (Republic of)\" >Moldova (Republic of)<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Macedonia (Republic of)\" >North Macedonia (Republic of)<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine (State of)\" >Palestine (State of)<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russian Federation\" >Russian Federation<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena, Ascension and Tristan da Cunha\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin (French part)\" >Saint Martin (French part)<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten (Dutch part)\" >Sint Maarten (Dutch part)<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia and the South Sandwich Islands\" >South Georgia and the South Sandwich Islands<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen\" >Svalbard and Jan Mayen<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syrian Arab Republic\" >Syrian Arab Republic<\/option><option value=\"Taiwan, Republic of China\" >Taiwan, Republic of China<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania (United Republic of)\" >Tanzania (United Republic of)<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"T\u00fcrkiye\" >T\u00fcrkiye<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom of Great Britain and Northern Ireland\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"United States Minor Outlying Islands\" >United States Minor Outlying Islands<\/option><option value=\"United States of America\" >United States of America<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Vatican City State\" >Vatican City State<\/option><option value=\"Venezuela (Bolivarian Republic of)\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands (British)\" >Virgin Islands (British)<\/option><option value=\"Virgin Islands (U.S.)\" >Virgin Islands (U.S.)<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_76-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_76\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-35063-field_76\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][76][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-35063-field_14-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"14\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-35063-field_14\">Passport<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_15-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_15\">Passport No <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-35063-field_15\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][15]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_77-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_77\">Issue Date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-35063-field_77\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][77][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-35063-field_17-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"17\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-35063-field_17\">Place of issue<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_75-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_75\">Place of Issue <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-35063-field_75\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][75]\" required=\"required\"><option value=\"Select Option\" >Select Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia (Plurinational State of)\" >Bolivia (Plurinational State of)<\/option><option value=\"Bonaire, Saint Eustatius and Saba\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cabo Verde\" >Cabo Verde<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos (Keeling) Islands\" >Cocos (Keeling) Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo\" >Congo<\/option><option value=\"Congo (Democratic Republic of the)\" >Congo (Democratic Republic of the)<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"C\u00f4te d&#039;Ivoire\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Kingdom of)\" >Eswatini (Kingdom of)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands (Malvinas)\" >Falkland Islands (Malvinas)<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard Island and McDonald Islands\" >Heard Island and McDonald Islands<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran (Islamic Republic of)\" >Iran (Islamic Republic of)<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland (Republic of)\" >Ireland (Republic of)<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Korea (Democratic People&#039;s Republic of)\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"Korea (Republic of)\" >Korea (Republic of)<\/option><option value=\"Kosovo\" >Kosovo<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People&#039;s Democratic Republic\" >Lao People&#039;s Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macao\" >Macao<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia (Federated States of)\" >Micronesia (Federated States of)<\/option><option value=\"Moldova (Republic of)\" >Moldova (Republic of)<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Macedonia (Republic of)\" >North Macedonia (Republic of)<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine (State of)\" >Palestine (State of)<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russian Federation\" >Russian Federation<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena, Ascension and Tristan da Cunha\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin (French part)\" >Saint Martin (French part)<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten (Dutch part)\" >Sint Maarten (Dutch part)<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia and the South Sandwich Islands\" >South Georgia and the South Sandwich Islands<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen\" >Svalbard and Jan Mayen<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syrian Arab Republic\" >Syrian Arab Republic<\/option><option value=\"Taiwan, Republic of China\" >Taiwan, Republic of China<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania (United Republic of)\" >Tanzania (United Republic of)<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"T\u00fcrkiye\" >T\u00fcrkiye<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom of Great Britain and Northern Ireland\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"United States Minor Outlying Islands\" >United States Minor Outlying Islands<\/option><option value=\"United States of America\" >United States of America<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Vatican City State\" >Vatican City State<\/option><option value=\"Venezuela (Bolivarian Republic of)\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands (British)\" >Virgin Islands (British)<\/option><option value=\"Virgin Islands (U.S.)\" >Virgin Islands (U.S.)<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_78-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_78\"> Expiry date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-35063-field_78\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][78][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-35063-field_20-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"20\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-35063-field_20\">Email<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_23-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_23\">Email (please use a Gmail account) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-35063-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_80-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_80\">Contact no<\/label><input type=\"tel\" id=\"wpforms-35063-field_80\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][80]\" value=\"65\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-35063-field_25-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"25\"><div id=\"wpforms-35063-field_25\"><div style=\"background-color:#002060; width:100%; padding:5px;\"> <div style=font-size:110%;padding-left:5px;><h1 style=color:white>Residential Address\u2013 Required for mailing of certificates<\/h1><\/div>\r\n<\/div><\/div><\/div><div id=\"wpforms-35063-field_100-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"100\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_100\">Residential address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-35063-field_100\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][100][address1]\" required><label for=\"wpforms-35063-field_100\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-35063-field_100-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][100][address2]\" ><label for=\"wpforms-35063-field_100-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-35063-field_100-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][100][city]\" required><label for=\"wpforms-35063-field_100-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-35063-field_100-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][100][state]\" required><label for=\"wpforms-35063-field_100-state\" class=\"wpforms-field-sublabel after \">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-35063-field_100-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][100][postal]\" required><label for=\"wpforms-35063-field_100-postal\" class=\"wpforms-field-sublabel after \">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-35063-field_100-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][100][country]\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-35063-field_100-country\" class=\"wpforms-field-sublabel after \">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-35063-field_44-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"44\"><div id=\"wpforms-35063-field_44\"><div style=\"background-color:#002060; width:100%; padding:5px;\"> <div style=font-size:110%;padding-left:5px;><h1 style=color:white>Family & Emergency Contact <\/h1><\/div>\r\n<\/div><\/div><\/div><div id=\"wpforms-35063-field_32-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"32\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-35063-field_32\">Family &amp; Emergency Contact <\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_34-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_34\">Full Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-35063-field_34\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][34]\" required><\/div><div id=\"wpforms-35063-field_33-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_33\">Relationship <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-35063-field_33\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][33]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_41-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_41\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-35063-field_41\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][41]\" required><\/div><div id=\"wpforms-35063-field_81-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"81\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_81\">Contact no<\/label><input type=\"tel\" id=\"wpforms-35063-field_81\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][81]\" value=\"65\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-35063-field_45-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"45\"><div id=\"wpforms-35063-field_45\"><div style=\"background-color:#002060; width:100%; padding:5px;\"> <div style=font-size:110%;padding-left:5px;><h1 style=color:white>Education Qualifications<\/h1><\/div>\r\n<\/div><\/div><\/div><div id=\"wpforms-35063-field_85-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"85\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-35063-field_85\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_84-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_84\">Highest relevant qualification attained <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-35063-field_84\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][84]\" required=\"required\"><option value=\"Select Option\" >Select Option<\/option><option value=\"Secondary\/ GCE \u2018O\u2019 Level\" >Secondary\/ GCE \u2018O\u2019 Level<\/option><option value=\"High school\/ GCE \u2018A\u2019 Level\" >High school\/ GCE \u2018A\u2019 Level<\/option><option value=\"Diploma\/ ITE\" >Diploma\/ ITE<\/option><option value=\"Associate\/ Bachelor\u2019s degree &amp; above\" >Associate\/ Bachelor\u2019s degree &amp; above<\/option><option value=\"Master&#039;s degree\" >Master&#039;s degree<\/option><option value=\"PhD\/ EdD\" >PhD\/ EdD<\/option><option value=\"Others, Please Specify\" >Others, Please Specify<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-35063-field_86-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"86\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_86\">Others ,Please Specify here <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-35063-field_86\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][86]\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-35063-field_52-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_52\">Please attach your highest relevant qualification certificate with transcripts. For non-native English speaker, please attach your highest English language proficiency results <span class=\"wpforms-required-label\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"52\"\n\t\tdata-form-id=\"35063\"\n\t\tdata-input-name=\"wpforms_35063_52\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages,json\"\n\t\tdata-max-size=\"268435456\"\n\t\tdata-max-file-number=\"5\"\n\t\tdata-post-max-size=\"268435456\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"#b1b1b1\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 5 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-35063-field_52\"\n\t\tname=\"wpforms_35063_52\" required\t\tvalue=\"\">\n<div class=\"wpforms-field-description\">Must include (Qualification \/ Award | School \/ Institution \/University | Country | Year Started | (DD\/MM\/YY) | Year Completed (DD\/MM\/YY)<\/div><\/div><div id=\"wpforms-35063-field_53-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"53\"><div id=\"wpforms-35063-field_53\"><div style=\"background-color:#002060; width:100%; padding:5px;\"> <div style=font-size:110%;padding-left:5px;><h1 style=color:white>Employment History<\/h1><\/div>\r\n<\/div><\/div><\/div><div id=\"wpforms-35063-field_54-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_54\">Please attach your recent CV with the required information <span class=\"wpforms-required-label\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"54\"\n\t\tdata-form-id=\"35063\"\n\t\tdata-input-name=\"wpforms_35063_54\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages,json\"\n\t\tdata-max-size=\"268435456\"\n\t\tdata-max-file-number=\"5\"\n\t\tdata-post-max-size=\"268435456\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"#b1b1b1\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 5 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-35063-field_54\"\n\t\tname=\"wpforms_35063_54\" required\t\tvalue=\"\">\n<div class=\"wpforms-field-description\">(1) Name of Company\r\n\r\n (2) Country\r\n\r\n(3) Period of Employment\r\n\r\n(4) Position Held<\/div><\/div><div id=\"wpforms-35063-field_55-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"55\"><div id=\"wpforms-35063-field_55\"><div style=\"background-color:#002060; width:100%; padding:5px;\"> <div style=font-size:110%;padding-left:5px;><h1 style=color:white>Course Programme Applying <\/h1><\/div>\r\n<\/div><\/div><\/div><div id=\"wpforms-35063-field_95-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"95\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_95\">Commencement date preferred<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-35063-field_95\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][95][date]\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-35063-field_118-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"118\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_118\">Select Programme <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-35063-field_118\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][118]\" required=\"required\"><option value=\"Select Course\" >Select Course<\/option><option value=\"IACT Practising Licence Programme: Special Needs Educational Therapist\" >IACT Practising Licence Programme: Special Needs Educational Therapist<\/option><option value=\"IACT Practising Licence Programme:  Dialogic-Diagnostic Arts Therapist\" >IACT Practising Licence Programme:  Dialogic-Diagnostic Arts Therapist<\/option><option value=\"IACT Practising Licence Programme: Special Needs Community Practitioner\" >IACT Practising Licence Programme: Special Needs Community Practitioner<\/option><option value=\"IACT Practising Licence Programme: Reading Therapy\" >IACT Practising Licence Programme: Reading Therapy<\/option><option value=\"Professional Diploma in Inclusive and Special Education\" >Professional Diploma in Inclusive and Special Education<\/option><option value=\"Diploma in Psychology\" >Diploma in Psychology<\/option><option value=\"Higher National Diploma in Early Childhood Education &amp; Care\" >Higher National Diploma in Early Childhood Education &amp; Care<\/option><option value=\"Diploma in Education and Training Management\" >Diploma in Education and Training Management<\/option><option value=\"Diploma in Health and Social Care Management\" >Diploma in Health and Social Care Management<\/option><option value=\"Postgraduate Diploma in Psycho-Educational Therapy\" >Postgraduate Diploma in Psycho-Educational Therapy<\/option><option value=\"Postgraduate Diploma in Diagnostic Projective Drawing &amp; Therapy\" >Postgraduate Diploma in Diagnostic Projective Drawing &amp; Therapy<\/option><option value=\"Postgraduate Diploma in Adolescent Development, Assessment &amp; Intervention (Youth Work)\" >Postgraduate Diploma in Adolescent Development, Assessment &amp; Intervention (Youth Work)<\/option><option value=\"Postgraduate Diploma in Child &amp; Adolescent Counseling &amp; Therapy\" >Postgraduate Diploma in Child &amp; Adolescent Counseling &amp; Therapy<\/option><option value=\"Executive Certificate: Autism Spectrum Disorder \u2013 Introduction [Level I] \" >Executive Certificate: Autism Spectrum Disorder \u2013 Introduction [Level I] <\/option><option value=\"Executive Certificate: Autism Spectrum Disorder \u2013 Assessment &amp; Treatment [Level II]\" >Executive Certificate: Autism Spectrum Disorder \u2013 Assessment &amp; Treatment [Level II]<\/option><option value=\"Executive Certificate: Autism Spectrum Disorder \u2013 Key Domains [Level III]\" >Executive Certificate: Autism Spectrum Disorder \u2013 Key Domains [Level III]<\/option><option value=\"Executive Certificate of Professional Practice: Special Needs Vocational Assessors [Level A]\" >Executive Certificate of Professional Practice: Special Needs Vocational Assessors [Level A]<\/option><option value=\"Executive Certificate of Professional Practice: Special Needs Vocational Assessors [Level B]\" >Executive Certificate of Professional Practice: Special Needs Vocational Assessors [Level B]<\/option><option value=\"Executive Certificate of Professional Practice: Special Needs Vocational Assessors [Level C]\" >Executive Certificate of Professional Practice: Special Needs Vocational Assessors [Level C]<\/option><option value=\"Executive Certificate: Counseling Students with Special Needs [Level I]\" >Executive Certificate: Counseling Students with Special Needs [Level I]<\/option><option value=\"Executive Certificate: Counseling Students with Special Needs [Level II]\" >Executive Certificate: Counseling Students with Special Needs [Level II]<\/option><option value=\"Executive Certificate: Adapted Physical Education for Students with Disabilities [Level I]\" >Executive Certificate: Adapted Physical Education for Students with Disabilities [Level I]<\/option><option value=\"Executive Certificate: Adapted Physical Education for Students with Disabilities [Level II]\" >Executive Certificate: Adapted Physical Education for Students with Disabilities [Level II]<\/option><option value=\"Executive Certificate: Disability &amp; Social Care Management \u2013  Diagnostic Categories [Level I] \" >Executive Certificate: Disability &amp; Social Care Management \u2013  Diagnostic Categories [Level I] <\/option><option value=\"Executive Certificate: Disability &amp; Social Care Management [Level II] \" >Executive Certificate: Disability &amp; Social Care Management [Level II] <\/option><option value=\"Executive Certificate: Introduction to Health &amp; Social Care Services\" >Executive Certificate: Introduction to Health &amp; Social Care Services<\/option><\/select><\/div><div id=\"wpforms-35063-field_60-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"60\"><div id=\"wpforms-35063-field_60\"><div style=\"background-color:#002060; width:100%; padding:5px;\"> <div style=font-size:110%;padding-left:5px;><h1 style=color:white>Learning Mode <\/h1><\/div>\r\n<\/div><\/div><\/div><div id=\"wpforms-35063-field_61-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_61\">Learning Mode <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-35063-field_61\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][61]\" required=\"required\"><option value=\"Select \" >Select <\/option><option value=\"Online (Distance)\" >Online (Distance)<\/option><option value=\"On Singapore campus (Foreign student visa subject to immigration approval)\" >On Singapore campus (Foreign student visa subject to immigration approval)<\/option><\/select><\/div><div id=\"wpforms-35063-field_63-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"63\"><div id=\"wpforms-35063-field_63\"><div style=\"background-color:#002060; width:100%; padding:5px;\"> <div style=font-size:110%;padding-left:5px;><h1 style=color:white> Personal statement <\/h1><\/div>\r\n<\/div><\/div><\/div><div id=\"wpforms-35063-field_62-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_62\">Explain why you want to take up the programme you have chosen <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-35063-field_62\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-words-enabled\" data-form-id=\"35063\" data-field-id=\"62\" data-text-limit=\"1000\" name=\"wpforms[fields][62]\" required><\/textarea><div class=\"wpforms-field-description\">Minimum 500 words required<\/div><\/div><div id=\"wpforms-35063-field_125-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"125\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_125\">Applicant\u2019s Required documents checklist <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-35063-field_125\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][125][]\" required=\"required\" multiple=\"multiple\"><option value=\"\" class=\"placeholder\" disabled >Select Multiple Options<\/option><option value=\"Select Multiple Options\" >Select Multiple Options<\/option><option value=\"\u2610 Resume\/ CV and employment testimonials\" >\u2610 Resume\/ CV and employment testimonials<\/option><option value=\"\u2610 Highest relevant qualifications certificates with transcripts\" >\u2610 Highest relevant qualifications certificates with transcripts<\/option><option value=\"\u2610 Applicant requested for exemptions based on Recognitions of Prior Learnings (Subject to approval by Head of Academic\/ Principal)\" >\u2610 Applicant requested for exemptions based on Recognitions of Prior Learnings (Subject to approval by Head of Academic\/ Principal)<\/option><option value=\"\u2610 Proof of highest English language proficiency for non-native speakers (if applicable)\" >\u2610 Proof of highest English language proficiency for non-native speakers (if applicable)<\/option><\/select><\/div><div id=\"wpforms-35063-field_94-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"94\"><div id=\"wpforms-35063-field_94\"><div style=\"background-color:#002060; width:100%; padding:5px;\"> <div style=font-size:110%;padding-left:5px;><h1 style=color:white> Declaration \u2013 All applicants must complete <\/h1><\/div>\r\n<\/div><\/div><\/div><div id=\"wpforms-35063-field_93-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"93\"><div id=\"wpforms-35063-field_93\">I declare that I have read and understood all the information provided by<strong> Merlion Academy (\u201cAcademy\u201d)<\/strong> in this application and that all of the information I have supplied in the application form, to the best of my knowledge, that are true and correct. I acknowledge that my application for enrolment is subject to acceptance by the Academy which has the right to impose conditions. I further acknowledge that in the event that my application for enrolment is accepted by the Academy and in consideration of the provision of educational resources by the Academy, I will be bound, by the provisions of the student handbooks, regulations and policies of the Academy, and will be subject to the lawful instructions of the Academy.<br><br>\r\n<h4>Confidentiality<\/h4>\r\nI understand that information contained on this form is collected for enrolment and administrative purposes. Personal information will not be passed onto any other external bodies without my authorisation unless a valid legal request has been made.<br><br>\r\nI consent to the collection, use and disclosing of personal data by the Academy for the purpose of processing my application for study, administration and funding purposes (where applicable), subject to the provisions of the Personal Data Protection Act (\u201cPDPA\u201d).<br><br>\r\nI consent to the reproduction and publication of any of my pictures or comments, taken by Merlion Academy in campus or in other events organised\/co-organised by the Academy to be used for marketing purposes.<\/div><\/div><div id=\"wpforms-35063-field_99-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"99\"><label class=\"wpforms-field-label\" for=\"wpforms-35063-field_99\">Terms &amp; Conditions <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-35063-field_99\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][99]\" required=\"required\"><option value=\"Select\" >Select<\/option><option value=\"I Agree\" >I Agree<\/option><\/select><\/div><\/div><div class=\"wpforms-submit-container\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"35063\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-35063\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/merlionacademy.sg\/cn\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Thank you for your interest in our program. Please complete the form below and pay an administrative fee of\u00a0SGD95\/- to process your application. Application Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"footnotes":""},"class_list":["post-35092","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/merlionacademy.sg\/cn\/wp-json\/wp\/v2\/pages\/35092","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/merlionacademy.sg\/cn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/merlionacademy.sg\/cn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/merlionacademy.sg\/cn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/merlionacademy.sg\/cn\/wp-json\/wp\/v2\/comments?post=35092"}],"version-history":[{"count":28,"href":"https:\/\/merlionacademy.sg\/cn\/wp-json\/wp\/v2\/pages\/35092\/revisions"}],"predecessor-version":[{"id":35191,"href":"https:\/\/merlionacademy.sg\/cn\/wp-json\/wp\/v2\/pages\/35092\/revisions\/35191"}],"wp:attachment":[{"href":"https:\/\/merlionacademy.sg\/cn\/wp-json\/wp\/v2\/media?parent=35092"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}