Phone Number *

(###)

###

####

On what semester do you want to join? *

Winter (December/January)

Spring Break (March)

Summer (May-August)

Other (Please Specify)

Date of Birth (Optional)

MM

DD

YYYY

Passport Expiration Date (Optional)

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I prefer to have my own room at an additional cost

Yes, I would like to pay an additional fee for my own room

No, I'm fine with a roommate

Emergency Contact Information *

First Name

Last Name