College Prep Institute Application

General Information

Student's first namerequired

Last/Family namerequired

Nickname

Student's advisor

Student's e-mailrequired

Parent's e-mailrequired

Student's mobile phone

Home phone

Country code if outside US

Grade completed before the start of summer schoolrequired

Have you attended Summer at Sem before?*

Yes No

How did you hear about Summer at Sem?

Do you have any relatives or friends who attended Wyoming Seminary?

College Prep Institute Application

School Information

Does the student currently attend Wyoming Seminary?*

Yes No

Are you a domestic student living within the United States or are you an international student?*

Domestic International

Student currently attendsrequired

School Namerequired

# of years attendedrequired

Complete street address of current schoolrequired

School phone w/ area coderequired

Country code (if outside U.S.)

School fax w/ area code

Family/Emergency Information

Student lives with*

Both parents Mother only Father only Guardian Other

Student's parents*

Married Divorced Separated Father deceased Mother deceased Other

Financial responsibility*

Both parents Father Mother Guardian

PARENT/GUARDIAN #1 INFORMATION

Please indicate the relationship of parent or guardian #1 to the student:required

First namerequired

Last namerequired

Email addressrequired

Cell number

Work number

Home number

Street Address (if different from student's)

Please enter "same as above" if your address matches the student's address.

City

State:

Country:

PARENT/GUARDIAN #2 INFORMATION

Please indicate the relationship of parent or guardian #2 to the student:

First name

Last name

Email address

Cell number

Work number

Home number

Street address (if different from student's)

Please enter "same as above" if your address matches the student's address.

City

State:

Country:

EMERGENCY CONTACT INFORMATION
Who is the emergency contact in the event that parents are unavailable?

Name of Contact Person living in the United States (if any)

Prefix
Firstrequired
Middle
Lastrequired
Suffix

Relationship to studentrequired

Address of Contact person living in the United States (if any)

Address 1required
Address 2
Address 3
Cityrequired
Staterequired
Region
Zip Coderequired (ex. 06108 or 06108-0809)
Country

Mobile Phone Numberrequired

with area/city code

Daytime Phone Number

Include area/city code

Evening Phone Numberrequired

with area/city code

Email Addressrequired

Student's Information

Student's gender*

Male Female

Birthdate (MM/DD/YYYY)required

Is the student a citizen of the United States?*

Yes No

Will the student attend boarding school in the U.S. after Summer at Sem?*

Yes No

Please provide name of boarding school

Address line 1required

Address line 2

Address line 3

Cityrequired

Staterequired

Zip code or country code

Country:required

Region

College Prep Institute Application

Boarding & Course Information

Will you be a boarding student?*

Yes No

Please note: Day students may register for a morning or afternoon course, or both. Boarding students must register for both a morning and afternoon course.
Current Sem students should confer with their advisor or class dean about their summer course selection before completing this form.

AM Course selection (9:00-11:30)

PM Course selection (12:30-3:00)

Would you like to apply for Summer Financial Aid?

Yes No

College Prep Institute Application

This form was completed by:required

First name:

Last name

Notes/Message to the Summer at Sem office:

Wyoming Seminary requires all boarding and day students to be in compliance with Pennsylvania State Immunization requirements. We do not accept exemptions. Questions regarding immunization requirements should be directed to Beth Blaum R.N., B.S.N. Director of Student Health Services, at (570) 270-2180.

Wyoming Seminary maintains an open admission policy. Any student, regardless of race, color, religion, national or ethnic origin, may apply for admission to the school. This policy embodies Wyoming Seminary's commitment to enriching students' experience by living in a multicultural community.

Application Fee

Application fees are $50 for domestic students and $125 for international students. There is no application fee for current Sem students. Your total is noted below. Please click the submit button to proceed to the next step.

Please send a confirmation email to the address below*:

Please provide an email address where we can send a link to your current form.

Email Address :