Application - Environmental Leadership in Hawaii

A Science & Culture Program for High School Students

Leadership in Hawaii will run April 2-9, 2010

My Information

Name: First Last
Address:
Street Address

Address Line 2

City

State

Zip/Postal Code

Country
Email:
Phone:
How old are you?
Gender Male Female
Have you previously attended a pre-college program at Brown University? Yes No
If yes, when and what class?

School Information

School Name
School Address:
Street Address

Address Line 2

City

State

Zip/Postal Code

Country
Type of School Public Private Home
What year do you expect to graduate high school?

Student Agreement

I understand that if I am accepted to and agree to attend a Brown University Pre-College Program, I will be required to abide by and be subject to that program's academic and social code. I have read and understand the application procedures, admissions, and refund policies for the category of courses I have selected.

YesNo

Parental Agreement and Contact Information

Please note: If student is under the age of 18, parental approval of participation must be given.

Permission is granted for my son, daughter, to participate, if selected, in a Brown University Pre-College Program. I understand the necessity for his/her conformance to the conditions and regulations of the Program and of Brown University.YesNo

Parent's Name
Parent's Preferred Email Address
Emergency Contact Information

Essay

Please write a 1 page statement describing what you hope to learn from this program.

Your completed application must include:

This Pre-College Application
A Teacher's Recommendation
An official school transcript
A $40 non-refundable application fee made out to "Brown University"

Mail all forms not completed online to:

Brown University Continuing Education
Attn: BELL Hawaii
42 Charlesfield St. Box T
Providence, RI 02912