ESL+ Language Programs Online Application

Application Process

Please complete the following and submit for your application to be considered by the Acceptance Committee. Once an applicant's file is complete, the committee notifies the family and/or consultant within two weeks. If accepted, the family receives direction on finalizing enrollment and preparing for a great summer at Mercersburg.

Click on this link-English Teacher Recommendation and download the form. The recommendation must be completed by a teacher or tutor and can be submitted after the online application has been completed.
Click on this link-Financial/Waiver Form and download the form. This form should be submitted via fax or email soon after completing the online application.
Submit a sample of the student's writing (an essay, short story, etc.) that has been reviewed by a teacher or tutor. This may be submitted after the online application has been completed.
Submit a good photocopy of the student's passport identification page. We prefer this item to be submitted via email, as an attachment.
Complete the online application below!

Select Program
Family Name*
First Name*
Middle Initial
Preferred English Name
Date of Birth (mm/dd/yy)*
Gender*	MF
Address*
Address2
City*
State
Zip Code*
Country*
Phone
Fax
City of Birth*
Country Of Birth:*
Country Of Citizenship:*
Current School:*
Current School Address:*
School Phone:
School Fax:
School Student will attend in September 2009
Grade Level 9/09:
2009 School Address
Student Preferred Email Address*
Shirt Size (Y: Youth, A:Adult)*	YLASAMALAXLAXXL
Indicate Student's Interests or Activities
Athletics
Music / Fine Arts
List travel experiences outside home country:
English Proficiency
Number of years student has studied English*
Please select estimated English proficiency level:
Family
Parent/Guardian I
Salutation	Mr.Ms.Mrs.Dr.Other
First name
Last name
Citizenship
Same address as student:
Address:
Home Phone:
Work Phone
Mobile Phone
Occupation*
Employer Address
Parent/Guardian II
First name
Last name
Salutation	Mr.Ms.Mrs.Dr.Other
Citizenship:
Same address as student:
Address:
Home Phone:
Work Phone:
Mobile Phone
Occupation*
Employer Address
Is there anything you would like us to know about your child or your family circumstance?

How do you know of our program?
Other:
Agent / Consultant (if applicable)
Company:
Contact:
Address:
City:
Country:
Phone:
Fax:
Email:
Correspondence
To whom should correspondence be sent?
Note: There is an application fee of $75.
I Accept $75 Application Fee*
Payment Options	Charge Balance to my card I will make payment through other means
Checking this box serves as my electronic signature and agreement for the Waiver-Agreement for Payment based on the above information.
I Accept: