Summer Semester Application

Candidate's Nickname, if applicable

Zip Code

Applicant is Male

Applicant is Female

Applicant's T-Shirt Size (Youth Size)

Medium Large X-Large

Applicant's T-Shirt Size (Adult Size)

Small Medium

Zip Code

Has your child applied to Eaglebrook for the regular school year?

Yes No

If your child has applied to the regular year, when did you submit the application?

If you are working with an educational consultant, please list that person's name here

Mother's Street Address

City

State

Country

Zip Code

Mother's Maiden Name

Mother's Telephone Number

Name of Business or Firm of Mother

Position

Mother's Business Street Address

City

State

Country

Zip Code

Mother's Business Telephone

Business Fax

Business Email

Street Address

City

State

Country

Zip Code

Father's Telephone Number

Name of Business or Firm of Father

Position

Father's Business Street Address

City

State

Country

Zip Code

Father's Business Telephone

Business Fax

Father's Business Email

Student Lives With

Parents Mother Father Stepmother Stepfather Other

Check if Applicable

Father Deceased Mother Deceased Parents Divorced Parents Separated Adopted Child

Language Spoken at Home

Language in which instruction is given in candidate's current school

Will you be requesting financial aid?

Yes No

I wish to enter my son/daughter in the following year of Summer Semester, in accordance with the conditions of admission explained in the current catalogue

2019

Application Fee Submitted by Mail