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GRAD COLLEGE PREP SUMMER CAMP APPLICATION

July 15-20, 2013

Application deadline June 10th 2013

PERSONAL INFORMATION

Name: First _________________________________ Last _______________________________

Birth date: ______/______/________ (mm/dd/yy)

Address: _________________________________________________City:_________________________

Home phone:______________________________ Cell phone:_________________________________

Email address: primary__________________________secondary:_______________________________

UNIVERSITY INFORMATION

Name of the University you are currently attending or attended in the past

_________________________________________________City:________________________________

What is your expected date of University graduation (if applicable)? ____/____/_____ (mm/dd/yy)

Your current work place (if applicable):

YOUR INTENDED MAJOR: ______________________________________

LIST OF COLLEGES YOU ARE PLANNING TO APPLY TO (if applicable):

1. __________________________________________

2. ___________________________________________

3. ___________________________________________

4. ____________________________________________

5. ____________________________________________

WORK EXPERIENCE(if any):

EXTRA-CURRICULAR ACTIVITIES(if any):

TOEFL/IELTS/GRE SCORES(if applicable):

To have your application considered you will need May 15 May 29 June 12 June 26 to take diagnostic TOEFL EducationUSA provides at American Corner on a monthly basis. Please choose one of the options

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Estimated camp fee is 15.000 tenge. Partial scholarships MIGHT become available, please check ONE of the boxes below:

I can pay for the camp

The ONLY way I can attend this camp is getting a partial scholarship

SIGNATURE

Signature of applicant:____________________________________ Date__________________________


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