c 1) Student Information

Indicate the Program You Prefer
   First Choice: Category Program Name Dates
   Second Choice: Category Program Name Dates

Name of Applicant as it Appears on Passport  Age
Nickname Date of Birth Sex Height  Weight
With whom does applicant live? Who should receive all mailings?
Applicant's email
Telephone Cell Phone
Current year in school Name of school applicant attends
Please list prior summer camps or programs
Please give names and year in school of applicant siblings, if any
What foreign languages have you studied and for how many years?
How did you first learn about Putney/Excel?
Extra-curricular activities in which you participate
 
Name of Parent  
Parent's address: Street City: State: Zip:
Occupation  Home #
Parent's e-mail  Cell #
Parent's place of employment                           Work #

Name of Parent  
Parent's address: Street City: State: Zip
Occupation  Home #
Parent's e-mail  Cell #
Parent's place of employment                     Work #

c 1b) Excel Applicants only (all others skip to section 2)
 
Course Selection (Excel at Amherst College)
 

 

Morning Course

Afternoon Course
First choice

Second choice


Course Selection (Excel Oxford/Tuscany, Paris/Provence, Madrid/Barcelona, China)

 

Major Course

Minor Course
First choice

Second choice

     
 c 1c) Excel Amherst Applicants only (all others skip to section 2)

 

 Note: All students at Excel Amherst participate in one elective off campus excursion weekend.  Please indicate your first and second choice for this weekend by choosing 1 and 2 in the boxes below.
 
   Exploration Weekend Selection
  Option 1: New Hampshire Wilderness, no fee
  Option 2: Cape Cod, supplemental fee $390
  Option 3: Montreal, supplemental fee $390
    
    Instructional Sports Clinic Selection
  No Clinic
  Soccer $240 (Amherst 3-week $190)
  Tennis $295 (Amherst 3-week $260)
  Golf $295 (Amherst 3-week $260)

c 2) Agreement
     I have read and I agree to the above Terms and Conditions.