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

Parent One Street Address

City

State

Country

Zip Code

Maiden Name (if applicable)

Parent One Telephone Number

Name of Business or Firm of Parent One

Position

Parent One Business Street Address

City

State

Country

Zip Code

Parent One Business Telephone

Business Fax

Business Email

Street Address

City

State

Country

Zip Code

Parent Two Telephone Number

Name of Business or Firm of Parent Two

Position

Parent Two Business Street Address

City

State

Country

Zip Code

Parent Two Business Telephone

Business Fax

Parent Two 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