\r\n KASEC Program Student Application<\/span>\r\n <\/h2>\r\n \r\n <\/div>\r\n <\/div>\r\n

<\/div>\r\n<\/div>\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Programs<\/h2>\t\t\t

\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t<\/label>\n\t\t\t\t\t\n\t\t\t\t<\/span>\n\n\t\t\t\t\t\n\t\n\t\n\t\n\t\n\t\t\t\n\t\t\n\t\t\t\n\n\t\n\t\t

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\n\t\t\t\t$<\/span>\t\t\t\tDonation Amount:<\/label>\n\t\t\t\t\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\tChoose Your Donation Amount:<\/label>Harmonia Ensemble<\/option>Inclusive Basketball - CLOSED<\/option>Golf Birdie Buddy - TBD<\/option>Dancing Stars - TBD<\/option>Mid-Program Registration<\/option><\/select>

Student Information<\/div><\/div>

\n Student's Legal Name \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n<\/div>

\n Student Nickname<\/label>\n\n<\/div>

\n Date of birth \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n<\/div>

\n Grade \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n<\/div>

\n Gender \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n\n Gender<\/option> \n Male <\/option>\n \n Female <\/option>\n \n Prefer not to say <\/option>\n <\/select>\n<\/div>

\n Diagnosis \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n<\/div>

\n Allergy \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n<\/div>

\n Any other medical issues? \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/i><\/span><\/label>\n\n\nPlease be as specific as you can<\/textarea>\n<\/div>

\n Any behavioral issues? \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/i><\/span><\/label>\n\n\nPlease be as specific as you can<\/textarea>\n<\/div>

\n What school program is your child a part of? \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/i><\/span><\/label>\n\n\nPlease be as specific as you can<\/textarea>\n<\/div>

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\n Are you currently receiving ABA service? \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n <\/legend>\n

\n Are you currently receiving ABA service? \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n <\/div>\n \n \n Yes <\/label>\n \n \n No <\/label>\n <\/fieldset>\n<\/div>

\n Student t-shirt size (Adult size) \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n\n - select -<\/option> \n Small <\/option>\n \n Medium <\/option>\n \n Large <\/option>\n \n X-Large <\/option>\n <\/select>\n<\/div>

Parent \/ Guardian<\/div><\/div>

\n Legal Name \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n<\/div>

\n Relationship \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n\n Relationship<\/option> \n Father <\/option>\n \n Mother <\/option>\n \n Legal guardian <\/option>\n \n Other <\/option>\n <\/select>\n<\/div>

\n Other<\/label>\n\n<\/div>

\n Phone Number \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n<\/div>

\n Email Address \n\t\t*<\/span>\n\t\tRequired<\/span>\n\t<\/span>\n<\/label>\n\n<\/div>

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\n\t\t\t\tSelect Payment Method\t\t\t<\/span>\n\t\t\t<\/span>\n\t\t<\/legend>\n\n\t\t

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• \n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t PayPal (Credit Card)<\/label>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\n\t\n\t
  \n\n\t\t\t

  \n\t\t

  \n\t\t\tPayment Information\t\t<\/legend>\n\n\t\t\n

  \n \n First Name *<\/span>\n <\/i><\/span> <\/label>\n \n <\/p>\n\n

  \n \n Last Name *<\/span>\n <\/i><\/span> <\/label>\n\n \n <\/p>\n\n \n

  \n \n Email Address *<\/span>\n <\/i><\/span> <\/label>\n \n\n <\/p>\n\n \n\t\t\t\t\t

  \n\t\t\t\t\n\t\t\t\t\tComment\t\t\t\t\t\t\t\t\t\t<\/i><\/span>\t\t\t\t<\/label>\n\n\t\t\t\t<\/textarea>\n\n\t\t\t<\/p>\n\t\t\t\t\t<\/fieldset>\n\t\t

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  Billing Details<\/legend>\n\t\t\t\t

  \n\t\t\t\n\t\t\t\tCountry\t\t\t\t\t\t\t\t\t*<\/span>\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t<\/label>\n\n\t\t\t\n\t\t\t\t<\/option>United States<\/option>Canada<\/option>United Kingdom<\/option>Afghanistan<\/option>Albania<\/option>Algeria<\/option>American Samoa<\/option>Andorra<\/option>Angola<\/option>Anguilla<\/option>Antarctica<\/option>Antigua and Barbuda<\/option>Argentina<\/option>Armenia<\/option>Aruba<\/option>Australia<\/option>Austria<\/option>Azerbaijan<\/option>Bahamas<\/option>Bahrain<\/option>Bangladesh<\/option>Barbados<\/option>Belarus<\/option>Belgium<\/option>Belize<\/option>Benin<\/option>Bermuda<\/option>Bhutan<\/option>Bolivia<\/option>Bosnia and Herzegovina<\/option>Botswana<\/option>Bouvet Island<\/option>Brazil<\/option>British Indian Ocean Territory<\/option>Brunei Darrussalam<\/option>Bulgaria<\/option>Burkina Faso<\/option>Burundi<\/option>Cambodia<\/option>Cameroon<\/option>Cape Verde<\/option>Cayman Islands<\/option>Central African Republic<\/option>Chad<\/option>Chile<\/option>China<\/option>Christmas Island<\/option>Cocos Islands<\/option>Colombia<\/option>Comoros<\/option>Congo, Democratic People's Republic<\/option>Congo, Republic of<\/option>Cook Islands<\/option>Costa Rica<\/option>Cote d'Ivoire<\/option>Croatia\/Hrvatska<\/option>Cuba<\/option>Cyprus Island<\/option>Czech Republic<\/option>Denmark<\/option>Djibouti<\/option>Dominica<\/option>Dominican Republic<\/option>East Timor<\/option>Ecuador<\/option>Egypt<\/option>Equatorial Guinea<\/option>El Salvador<\/option>Eritrea<\/option>Estonia<\/option>Ethiopia<\/option>Falkland Islands<\/option>Faroe Islands<\/option>Fiji<\/option>Finland<\/option>France<\/option>French Guiana<\/option>French Polynesia<\/option>French Southern Territories<\/option>Gabon<\/option>Gambia<\/option>Georgia<\/option>Germany<\/option>Greece<\/option>Ghana<\/option>Gibraltar<\/option>Greenland<\/option>Grenada<\/option>Guadeloupe<\/option>Guam<\/option>Guatemala<\/option>Guernsey<\/option>Guinea<\/option>Guinea-Bissau<\/option>Guyana<\/option>Haiti<\/option>Heard and McDonald Islands<\/option>Holy See (City Vatican State)<\/option>Honduras<\/option>Hong Kong<\/option>Hungary<\/option>Iceland<\/option>India<\/option>Indonesia<\/option>Iran<\/option>Iraq<\/option>Ireland<\/option>Isle of Man<\/option>Israel<\/option>Italy<\/option>Jamaica<\/option>Japan<\/option>Jersey<\/option>Jordan<\/option>Kazakhstan<\/option>Kenya<\/option>Kiribati<\/option>Kuwait<\/option>Kyrgyzstan<\/option>Lao People's Democratic Republic<\/option>Latvia<\/option>Lebanon<\/option>Lesotho<\/option>Liberia<\/option>Libyan Arab Jamahiriya<\/option>Liechtenstein<\/option>Lithuania<\/option>Luxembourg<\/option>Macau<\/option>Macedonia<\/option>Madagascar<\/option>Malawi<\/option>Malaysia<\/option>Maldives<\/option>Mali<\/option>Malta<\/option>Marshall Islands<\/option>Martinique<\/option>Mauritania<\/option>Mauritius<\/option>Mayotte<\/option>Mexico<\/option>Micronesia<\/option>Moldova, Republic of<\/option>Monaco<\/option>Mongolia<\/option>Montenegro<\/option>Montserrat<\/option>Morocco<\/option>Mozambique<\/option>Myanmar<\/option>Namibia<\/option>Nauru<\/option>Nepal<\/option>Netherlands<\/option>Netherlands Antilles<\/option>New Caledonia<\/option>New Zealand<\/option>Nicaragua<\/option>Niger<\/option>Nigeria<\/option>Niue<\/option>Norfolk Island<\/option>North Korea<\/option>Northern Mariana Islands<\/option>Norway<\/option>Oman<\/option>Pakistan<\/option>Palau<\/option>Palestinian Territories<\/option>Panama<\/option>Papua New Guinea<\/option>Paraguay<\/option>Peru<\/option>Philippines<\/option>Pitcairn Island<\/option>Poland<\/option>Portugal<\/option>Puerto Rico<\/option>Qatar<\/option>Reunion Island<\/option>Romania<\/option>Russian Federation<\/option>Rwanda<\/option>Saint Helena<\/option>Saint Kitts and Nevis<\/option>Saint Lucia<\/option>Saint Pierre and Miquelon<\/option>Saint Vincent and the Grenadines<\/option>San Marino<\/option>Sao Tome and Principe<\/option>Saudi Arabia<\/option>Senegal<\/option>Serbia<\/option>Seychelles<\/option>Sierra Leone<\/option>Singapore<\/option>Slovak Republic<\/option>Slovenia<\/option>Solomon Islands<\/option>Somalia<\/option>South Africa<\/option>South Georgia<\/option>South Korea<\/option>Spain<\/option>Sri Lanka<\/option>Sudan<\/option>Suriname<\/option>Svalbard and Jan Mayen Islands<\/option>Eswatini<\/option>Sweden<\/option>Switzerland<\/option>Syrian Arab Republic<\/option>Taiwan<\/option>Tajikistan<\/option>Tanzania<\/option>Togo<\/option>Tokelau<\/option>Tonga<\/option>Thailand<\/option>Trinidad and Tobago<\/option>Tunisia<\/option>Turkey<\/option>Turkmenistan<\/option>Turks and Caicos Islands<\/option>Tuvalu<\/option>Uganda<\/option>Ukraine<\/option>United Arab Emirates<\/option>Uruguay<\/option>US Minor Outlying Islands<\/option>Uzbekistan<\/option>Vanuatu<\/option>Venezuela<\/option>Vietnam<\/option>Virgin Islands (British)<\/option>Virgin Islands (USA)<\/option>Wallis and Futuna Islands<\/option>Western Sahara<\/option>Western Samoa<\/option>Yemen<\/option>Yugoslavia<\/option>Zambia<\/option>Zimbabwe<\/option>\t\t\t<\/select>\n\t\t<\/p>\n\n\t\t

  \n\t\t\t\n\t\t\t\tAddress 1\t\t\t\t\t\t\t\t\t*<\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\t\t\t<\/label>\n\n\t\t\t\n\t\t<\/p>\n\n\t\t

  \n\t\t\t\n\t\t\t\tAddress 2\t\t\t\t\t\t\t\t<\/i><\/span>\t\t\t<\/label>\n\n\t\t\t\n\t\t<\/p>\n\n\t\t

  \n\t\t\t\n\t\t\t\tCity\t\t\t\t\t\t\t\t\t*<\/span>\n\t\t\t\t\t\t\t\t<\/i><\/span>\t\t\t<\/label>\n\t\t\t\n\t\t<\/p>\n\n\t\t\t\t

  \n\t\t\t\n\t\t\t\tState<\/span>\n\t\t\t\t*<\/span>\n\t\t\t\t<\/span>\n\t\t\t<\/label>\n\t\t\t\t\t\t\t\n\t\t\t\t\t<\/option>Alabama<\/option>Alaska<\/option>Arizona<\/option>Arkansas<\/option>California<\/option>Colorado<\/option>Connecticut<\/option>Delaware<\/option>District of Columbia<\/option>Florida<\/option>Georgia<\/option>Hawaii<\/option>Idaho<\/option>Illinois<\/option>Indiana<\/option>Iowa<\/option>Kansas<\/option>Kentucky<\/option>Louisiana<\/option>Maine<\/option>Maryland<\/option>Massachusetts<\/option>Michigan<\/option>Minnesota<\/option>Mississippi<\/option>Missouri<\/option>Montana<\/option>Nebraska<\/option>Nevada<\/option>New Hampshire<\/option>New Jersey<\/option>New Mexico<\/option>New York<\/option>North Carolina<\/option>North Dakota<\/option>Ohio<\/option>Oklahoma<\/option>Oregon<\/option>Pennsylvania<\/option>Rhode Island<\/option>South Carolina<\/option>South Dakota<\/option>Tennessee<\/option>Texas<\/option>Utah<\/option>Vermont<\/option>Virginia<\/option>Washington<\/option>West Virginia<\/option>Wisconsin<\/option>Wyoming<\/option>American Samoa<\/option>Canal Zone<\/option>Commonwealth of the Northern Mariana Islands<\/option>Federated States of Micronesia<\/option>Guam<\/option>Marshall Islands<\/option>Northern Mariana Islands<\/option>Palau<\/option>Philippine Islands<\/option>Puerto Rico<\/option>Trust Territory of the Pacific Islands<\/option>Virgin Islands<\/option>Armed Forces - Americas<\/option>Armed Forces - Europe, Canada, Middle East, Africa<\/option>Armed Forces - Pacific<\/option>\t\t\t\t<\/select>\n\t\t\t\t\t<\/p>\n\n\t\t

  \n\t\t\t\n\t\t\t\tZip \/ Postal Code\t\t\t\t*<\/span>\n\t\t\t\t<\/i><\/span>\t\t\t<\/label>\n\n\t\t\t\n\t\t<\/p>\n\t\t\t<\/fieldset>\n\t\t

  \n\t\t

  Terms<\/legend>\n\t\t

  \n\t\t\t

  \ub098\ub294 \ud504\ub85c\uadf8\ub7a8\uc758 \ube44\uc6a9\uc774 KASEC \ud504\ub85c\uadf8\ub7a8 \uae30\uae08\uc73c\ub85c\ubd80\ud130 \ubcf4\uc870 \ubc1b\ub294\ub2e4\ub294 \uac83\uc744 \uc778\uc9c0\ud558\uace0 \uc218\ub77d\ud569\ub2c8\ub2e4.<\/strong>
  \nI understand and accept that program fees are subsidized by KASEC program fund.<\/strong><\/p>\n

  \n
  1. Korean American special education center is not responsible for any injury or accidents during the services provided by kasec. *<\/li>\n
  2. I verify this information is true to the best of my knowledge. Applications with falsified information will not be considered.*<\/li>\n
  3. I fully authorize and grant the Korean American special education center and its authorized representatives has my permission to use my or my child\u2019s photograph publicly to promote the center.<\/li>\n
  4. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.*<\/li>\n
  5. The registration fee is required for all qualified applications. This fee is not refundable and cannot be credited against any other charges.<\/li>\n
  6. I have read all of kasec student policies & behavior contract and understood them completely.*<\/li>\n<\/ol>\n\t\t<\/div>\n\t\t
     \n\t\t\tShow Terms<\/a>\n\t\t\tHide Terms<\/a>\n\t\t<\/div>\n\n\t\t\n\t\tBy checking this box you acknowledge that you have fully read, understood, and agreed with the\r\nPolicies.<\/label>\n\n\t<\/fieldset>\n\t\t

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     \n\t\t\t\t\n\t\t\tTotal\t\t<\/span>\n\t\t\n\t\t\t$300.00\t\t<\/span>\n\t\t\t<\/p>\n\t

     {amount} donation plus {fee_amount} to help cover fees.<\/p>\t\n\t\n\t\t

     \n\t\t\n\t\t<\/span>\n\t<\/div>\n\t\t<\/fieldset>\n\t\n\t<\/div>\n\n\t\t\t\t<\/form>\n\n\t\t\t\n\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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     Don\u2019t have PayPal account? Click \u201cCheckout as Guest\u201d or \u201cPay with Debit or Credit Card\u201d<\/p>\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

     KASEC Program Student Application Don\u2019t have PayPal account? Click \u201cCheckout as Guest\u201d or \u201cPay with Debit or Credit Card\u201d<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/kasecca.org\/wp-json\/wp\/v2\/pages\/5496"}],"collection":[{"href":"https:\/\/kasecca.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/kasecca.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/kasecca.org\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kasecca.org\/wp-json\/wp\/v2\/comments?post=5496"}],"version-history":[{"count":24,"href":"https:\/\/kasecca.org\/wp-json\/wp\/v2\/pages\/5496\/revisions"}],"predecessor-version":[{"id":13139,"href":"https:\/\/kasecca.org\/wp-json\/wp\/v2\/pages\/5496\/revisions\/13139"}],"wp:attachment":[{"href":"https:\/\/kasecca.org\/wp-json\/wp\/v2\/media?parent=5496"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}