Supported Immersion Programs: Initial Inquiry Form
Hello! Thank you for your interest in Supportive Immersion experiences. You're taking the first step to opening up your world to a powerful learning experience! Please take some time to complete the following questionnaire so we may know a little more about your interests. We will follow up with you to continue the dialogue once we receive this submission. Thank you!
* Required
Email address
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Your email
Program of Interest
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Choose
Sibanye South Africa Summer Program
TREKS - 2 week international trips (South Africa)
TREKS - 2 week international trips (other location)
The Bridge - Costa Rica (supportive gap program)
New Summit Academy - Costa Rica (boarding high school)
First & Middle Names
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Your answer
Last Name(s)
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Your answer
Please indicate your gender identification:
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Current Age
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Your answer
Dates Available for Experience
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Your answer
Passport issued by ___ (Country)
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Your answer
Current Education Status
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Completing high school graduation
Currently participating in a gap or transition program
Currently working or completing an internship
Currently in college / university
Graduated from college / university
Other:
How did you hear about us?
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Your answer
Please tell us about your interests (hobbies, extracurriculars, study or career interests, etc.)
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Your answer
Please tell us about any previous international travel or study abroad experiences:
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Your answer
Tell us why you are interested in possibly participating in this program:
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Your answer
Send me a copy of my responses.
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