Inquiry Request Form for Customized Group

Once this form is completed and submitted, please allow approximately 4 weeks for a sample of calendar and costs based on your request.  Please send a reminder email to Ms. Kazumi Hada, Director of OIE, at, if you don’t hear from us for more than 4 weeks from your submission date.

  • Contact Person's NAME: * Required
  • Please provide the following information in order to have a sample calendar and costs from Bellevue College (BC):

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY

    * BC requires an adult chaperone to accompany the program, (at least for the first several days until the students settle in).
    * An adult guardian is required if students are below 18 years of age. All underage students’ parents must complete these two Release forms: the Underage - Attorney-In-Fact Contact Info form and the Underage - Power of Attorney for Health Care form.
    * Weekly ESL instructional hours must be kept under 18 hours.
    * This is a closed program. The customized group students will not be mixing with other BC students.
    * There is no agency referral fee paid to the organizing agency.
    * BC strongly recommends that the organizer plan a program at least six (6) months or a year in advance. We may decline your request if there is not enough preparation time.
    * Per the Customized program contract, BC requires a verbal commitment on the 90th day before the program commencement date, 50 percent down-payment by the 60th day prior to program start date, and balance due by the 30th day, or cancellation confirmation.
    * BC reserves the right to withhold 20 percent of the down payment or the amount of the expenses already incurred in preparation for the program prior to the cancellation date, whichever amount is higher.



Last Updated October 24, 2018