Elmhurst College Collegiate Immersion Program in America 2019

Student Information

First/Given Name

Preferred First Name

Last/Family Name

Gender

Female

Male

Birthdate

International Address (please provide address as it should appear in order for mail to be received)

Country

Street

City

Region

Postal Code

Home Phone Number

Student Cell/Mobile Number

Student Email Address

Parent Information

Parent Given/First Name

Parent Last/Family Name

Parent Type

Parent Home Phone Number

Parent Cell/Mobile Number

Citizenship Information

Country of Citizenship

Country of Birth

Language(s) Spoken at Home

Academic Information

Secondary/High School Name

Secondary High School Mailing Address (please provide address as it should appear in order for mail to be received)

Country

Street

City

Region

Postal Code

Grade/Year Completed in 2018-2019 School Year

Grade/Year 9 (letter of recommendation from school principal & high school transcript required)

Grade/Year 10

Grade/Year 11

Academic Course Preference

First Preference

Second Preference

Please note that that course selection will be determined based on the number of participants in the College Immersion Academy overall, and your first choice selection is not guaranteed.

Next Steps

1. Upload an "unlisted" video of no more than two minutes in length to YouTube.com sharing with us why you are interested in the Collegiate Immersion Program at Elmhurst College.

YouTube Link

2. Upload a copy of your passport photo page.

Terms and Conditions:

Disclaimer: By submitting a video to the Summer Immersion Program Competition, you agree to allow Elmhurst College to use your videos for future marketing purposes and shared on social media. Determination of a video’s suitability to be featured is up to the discretion of the Elmhurst College Office of Communications and Public Affairs. Videos that include inappropriate content, language or graphics will be disqualified.

I agree to the Terms and Conditions stated above.

By submitting this application, I certify that it is true, correct and honestly presented.

In place of your signature, please type your full legal name: