Pre College Program Application

Round

Created

Submitted

Term

Participant Contact and Personal Information

Participant's First Name

Participant's Preferred Name

Participant's Middle Name

Participant's Last Name

Participant's Mailing Address

Country

Street

City

Region

Postal Code

Participant's Mobile Phone

Participant's Email Address

Parent/Guardian Type

Parent/Guardian First

Parent/Guardian Last

Parent/Guardian Mobile Phone

Parent/Guardian Email Address

Sex

Participant's Birthdate

Are you Hispanic or Latinx

Yes

No

Primary Citizenship

Please enter your Social Security Number.
This information is securely stored and is required by the university Registrar and Bursar. If you'd prefer to provide this via the phone or to schedule a time in person, please call 860-465-4543.

If you have a roommate preference, please list their name here:

Roommate assignments are made based on gender and high school class standing. If you would like to request non-binary gender housing, please check the box here.
*Please note that while we can’t guarantee this option will be available at this point, we will do everything we can to accommodate your request*

Yes

No/Not Applicable

Education

In Fall 2024, I will be entering

Current School Attending

CEEB

Current Grade Point Average (GPA)

Please list the highest level of education for Parent/Guardian 1.

Less than a high school diploma

High school diploma

2-year college degree (Associate's)

4-year college degree or beyond (Bachelor's or Master's)

Prefer not to answer/Not Applicable/Not sure

Please list the highest level of education of Parent/Guardian 2.

Less than a high school diploma

High school diploma

2-year college degree (Associate's)

4-year college degree or beyond (Bachelor's or Master's)

Prefer not to answer/Not Applicable/Not sure

Program Selection

Please identify which program (s) you would like to request. Registration will be processed on a first come, first serve basis.

For which program are you applying for in week one? (Sunday, July 14th to Friday, July 19th)

Resilience: The Science of Grit and Overcoming

A Brief History of Horror

Creative Writing Studio

True Crime: An American Obsession - This program contains some graphic and violent content that some students may find disturbing. By applying for this program, you are agreeing that you expect to be comfortable with the material and understand that this topic will address crime and violence throughout the week.

None

For which program are you applying for in week two? (Sunday, July 21st to Friday, July 26th)

Health Heroes 101: Unleashing Creativity to Conquer Disease

Pre-Med Lab: How the Human Body Works

Introduction to Filmmaking

Visual Stories in Augmented Reality

None

Program Submission

By submitting my application, I agree to have an Eastern ID & account generated and that participation in this program, which has a cost of $1,600 per week ($3,200 for 2 weeks), has the support of the participant's parent or guardian.

*Please note that Eastern is unable to house participants between programs if they opt to enroll in both weeks*

Yes, I agree.

No, I do not agree.