Register Student · Non-Member Agency

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Personal Information * required fields

Name (Passport)*
Name (Local / Home language)*
Gender*	Male Female Other
Birthdate*	Age: — Age is auto-computed from birthdate. Date will be submitted as YYYY-MM-DD format automatically.
Nationality*	KRN South Korea JPN Japan CHN China TWN Taiwan VNM Vietnam ARB GCC / Middle East MGN Mongolia Others 📝
Occupation
English Level
Phone number (home country)*
Telephone (alternate / landline)
E-mail (Student)*
Address (in home country)
Photo (optional)	ID photo or profile picture (JPG/PNG/WebP, max 8 MB). Optional.
Remarks
CELLA Memo (internal CRM use)
Deposit Memo (financial)

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Program & Campus

Start Date*
Total Duration (Weeks)	If filled, End Date auto-calculated (Start + N weeks).
End Date	Overrides auto-calculation if set.
Campus*	Premium Campus Uni Campus
Dormitory Type*	—
📚 Course / Duration (Weeks) Grouped by family tag · Multiple courses permitted	💡 Type the number of weeks for each course to include. Weeks = 0 means not selected. Example: `ESL 8 wks` + `IELTS Intensive 4 wks` = 12-week combined program. 💡 How to add courses: Type the number of weeks for each course you want to include. Weeks = 0 means not selected. Example: General ESL `8` + IELTS Intensive `4` = 12-week combined program. ESL 5 courses▼ Expreser 1 Expreser 2 Light ESL Power Speaking 1 Power Speaking 2 TOEIC 2 courses▼ TOEIC Intensive TOEIC Preparation IELTS 3 courses▼ IELTS Guarantee IELTS Intensive IELTS Preparation Working Holiday 2 courses▼ Working Holiday 1 Working Holiday 2 ACE 2 courses▼ ACE 1 ACE 2 Business English 2 courses▼ Business Intensive Business Preparation Family 2 courses▼ Family 1 Family 2 💡 Selected courses (weeks > 0) will appear in Live Summary right panel in "Program" section.
Medical / Dietary / Notes

✈️

Flight & Arrival (Optional, can be filled later)

Flight Number
Point of Departure
Arrival Date
Arrival Time
Pickup / Airport Notes

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Agency & Contact Information * required

Agency Name (Recorded)	Automatically assigned by CRM. Cannot be changed.
CRM Manager Format	✅ Stored as: `Manager Name · Company Name` Example: `Kim Min-woo · Seoul Study Co.`
Company / Agency Name*
Manager / Contact Person*	Concat preview: Manager Name · Company Name
Manager Email*
Manager Contact*

Privacy & Policy: By submitting you confirm all details are accurate and agree to CELLA Academy's enrollment policies. Manager contact info is used only for admissions communication.

Cancel & Back

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Live Registration Summary

Updates in real-time as you fill the form

📋 Student Information

Birthdate—

Nationality—

Level—

Occupation—

Phone—

Alt. Phone—

Email—

Address—

Photo—

Remarks—

CELLA Memo—

Deposit Memo—

📚 Program

CourseGeneral ESL

Dorm—

Total Duration— wks

🗓️ Dates

Start—

End—

Campus—

✈️ Flight Info

Flight No—

Arrival—

From—

🏢 Agency (Non-Member)

Agency(Non-Member)

Manager—

Email—

Contact—