* Required

Student Information:

First Namerequired

Middle Name

Last Namerequired

Genderrequired

Date of Birthrequired (mm/dd/yyyy)

Citizenshiprequired

Student Email

Street Addressrequired

State/Province

Cityrequired

Zip/Postal Code

Countryrequired

Current School Namerequired

Current Graderequired

Does the applicant have special needs that the school should be aware of?*

Yes No

Please explain.required

Father

First Namerequired

Middle Name

Last Namerequired

Home Telephonerequired

Mobile Telephonerequired

Emailrequired

Work Telephone

Mother

First Namerequired

Middle Name

Last Namerequired

Home Telephonerequired

Mobile Telephonerequired

Emailrequired

Work Telephone

Representation

Are you working with an agent, consultant, or other form of representation?*

Yes No

Name of Agencyrequired

Agency Contact Namerequired

Agency Address

Address 1
Address 2
Address 3
City
State
Region
Zip Code (ex. 06108 or 06108-0809)
Country

Agency Telephonerequired

Agency Fax Numberrequired

Agency Emailrequired

Additional Information

How did you hear about the Perkiomen School?

Does the applicant have any relatives of friends that are associated with the Perkiomen School?

Yes No

Please provide their name and describe the relationshiprequired

Application Feerequired

Required Application Materials:

Complete summer program application with fee

Writing sample

Transcript with current grades and previous year grades

TOEFL, TOEFL Jr., or IELTS score report, if available

Submit requested application materials to admissions@perkiomen.org with the subject line Summer Program Application Materials

Please send a confirmation email to the address below*: