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Full Name (First, Middle, Last)
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Date of Birth
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First
Last
Gender
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Male
Female
Nationality
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Current Country of Residence
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--- Select Choice ---
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic (Czechia)
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine*
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan**
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City (Holy See)*
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Email Address (primary communication)
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Mobile Number (with country code)
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WhatsApp Number (optional, if different)
Emergency Contact (optional)
Native Language
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Other Languages Spoken
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Do you know your English level? (Yes/No → If No → Take Placement Test)
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If Yes, what is your English Level?
Program Interest
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English Regular Program
English Plus Program
English for Specific Purposes Program (ESP)
English for Academic Purposes Program (EAP)
International English Test Preparation Programs
None English Language Programs
Preferred Class Schedule (KSA)
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08:30 AM - 10:35 AM (Morning)
11:00 AM - 01:05 PM (Morning)
02:00 PM - 04:05 PM (Afternoon)
04:15 PM - 06:20 PM (Afternoon)
06:30 PM - 07:35 PM (Evening)
07:45 PM - 09:50 PM (Evening)
Do you have reliable internet access?
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Yes
No
Do you have a laptop/PC or smartphone for Zoom classes?
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Yes
No
Are you interested in Scholarships or Financial Aid?
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Yes
No
Scholarships EduRaise? &
If Yes, please explain briefly why you believe you deserve financial aid or Scholarships.
(Example: financial hardship, refugee status, unemployment, etc.) Important Note: Scholarship and financial aid requests will be reviewed carefully by EduRaise’s team, and responses may take time. Approval is not guaranteed and will depend on available funding and eligibility criteria.
Consent & Agreements
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I agree to EduRaise’s Terms of Service and Privacy Policy.
I consent to my data being securely stored and processed for academic purposes.
I understand that EduRaise classes are live and attendance is required.
How did you hear about EduRaise? (Instagram / Facebook / LinkedIn / Friend / Advertisement / Other)
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