Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Home Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Parent(s) Address (if different from above) *

Parent or Legal Guardian Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

(###)

###

####

High School Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Received an accredited diploma? *

Yes

No

expected Graduation Date *

MM

DD

YYYY

REQUIRED ITEMS THAT MUST ACCOMPANY APPLICATION: *

Official transcript

Official copy of SAT or ACT score

2 Letters of recommendation (1 from a teacher & 1 from a school administrator OR church leader OR community leader}

2 Essay question responses

College acceptance letter

Personal photography (headshot)

Information and Photo Release form