NY Empire Academy

First name

Last name

Gender

Date of Birth

Current School Name

Grade

Country / Region *

Mother Full Name

Father Full Name

Personal E-Mail

Parent E-Mail

Personal Phone

Parent Phone

How did you hear us?

Passport PDF-JPG-JPEG-PNG

English Proficiency IELTS,TOEFL,CEPT PDF-JPG-JPEG-PNG

Travel Consent PDF-JPG-JPEG-PNG

Parent Passport or National ID PDF-JPG-JPEG-PNG

Product

Subtotal

NASA TRAINING SUMMER
With fly ticket

$5,950.00

NASA TRAINING SUMMER
With fly ticket

First Pay (%30)

$1,785.00

Transaction Fee

$58.91

Total

$1,843.91

Bank Pay Invoice

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