Student Application ( 1 of 3 )

Note: To apply for our year-long Latitudes program please go to the Latitudes Online Application.

Please note that you'll be asked to answer the following essay questions on page 3
(Suggested total length is about 2 pages).

  • 1. What is your inspiration for going on this program? What do you hope to gain from taking part in a group-oriented program?
  • 2. Describe in detail three areas of your life in which you'd like to grow.
  • 3. What single event or experience of your life had the most impact on your life? Why?
  • 4. Drugs and alcohol are big problems for many people - please describe your relationship with each one. Do you smoke? Why do you want to stay free from drugs and alcohol for a full 3 months?

Personal Information

Your Name
Home Telephone###-###-###
Cell Phone###-###-###
Fax 
EmailThis is our primary form of communication
Facebook or MyspaceIf available
Best method and time of day to contact you 

Semester Program

Season
Spring 2010
Fall 2010
Spring 2011
Fall 2011
Region
India
Central America
Australia/New Zealand/Fiji
Africa
South America
Southeast Asia
Summer in Japan

Payment

Please bill my VISA or MasterCard for $100:
 
Card # 
CVV Code3 digits
Expirationmm/yy
Billing Addressstreet or PO address only
Billing ZIP Code 

(Please do not use the browser back and forward buttons when filling out this application.)