Classroom Without Walls Application

To apply for enrollment, please fill out all required boxes. After pressing “Submit,” you will be directed to a thank-you page. All the applications will be reviewed by the staff and you will be informed if you are accepted into the program.

If you are accepted, you will receive a link that direct you to pay the tuition in full amount ($5,500) or two payments ($2,800 for each payment by the end of Oct and the end of November.)

Application for Ten-Day Immersion in Singapore 2019

Name *
Name
Mailing Address *
Mailing Address
Home Phone *
Home Phone
Cell Phone
Cell Phone
Birth Date *
Birth Date
Passport Status *
PRIMARY ADULT CONTACT INFORMATION
(This parent or guardian with legal custody is our primary contact for enrollment, billing, and emergencies.)
Parent or Guardian Name *
Parent or Guardian Name
Daytime Phone *
Daytime Phone
Evening Phone *
Evening Phone
If address is different from participant's address, please fill in below:
Address
Address
SECOND ADULT CONTACT INFORMATION
(This parent, guardian, or other adult is our backup contact and will receive certain important emails.)
Name *
Name
Daytime Phone *
Daytime Phone
Evening Phone *
Evening Phone
If address is different from participant's address, please fill in below:Section 3
Address
Address
HEALTH QUESTIONS
Is the participant, or has the participant in the past 24 months been under the care of a physician, psychologist, or psychiatrist? (Ignoring routine check-ups) *
Is there any information about the participant’s physical or mental health that might have some bearing on their trip? *
Is the participant currently taking any prescribed medications? *
PARTICIPANT QUESTIONS
Please answer the following three questions with 1-2 paragraphs each.
Can you navigate a small city or airport on your own? *
Can you wake yourself up at a certain time if necessary, and can you keep track of time on your own? *
SUBMISSION
We only use application information for contacting parents/guardians concerning enrollment, billing, or emergencies. We respect your privacy and do not sell or rent your information to third parties. We do add your email addresses to our Classroom Without Walls notification list to update you with immersion programs and important updates regarding school developments and scholarships.. If you'd like to remove yourself from that list, it's a simple one-click unsubscribe. When you are ready to apply, please click "Submit." A copy of the application will be emailed to the participant and primary parent/guardian.