Zanzibar Cultural Immersion Trip Application
Personal and Academic Information
Applicant's Full Name (as it appears on passport) *
Preferred Name
Student ID Number *
(You can find this information on the student portal.)
Year of Graduation *
(at time of application)
Do you identify as... *
Home Address *
Applicant's e-mail (@brooklinek12.org) *
Parent/Guardian #1 Full Name *
Parent/Guardian #1 email *
Parent/Guardian #2 Full Name *
Parent/Guardian #2 email *
Alternate Emergency Contact Info *
(email and cell phone number)
Core Academic and Elective Teachers, 2018-2019 *
For example: Smith (Math), Jones (Chemistry), etc.
Dean and Guidance Counselor *
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