Apply

Student Information

 Please note, you must be over the age of 18 to apply for this programme

All items marked with * are required.

First Name*:
Last Name*:
Date of Birth*:
Gender*: MF
Social Security Number*:
Do you wish to apply for financial aid?*: YesNo
Email*:
Tel*:
Fax:
Home Address*:
City*
State/Province*
Zip/Postal Code*:
Country* :


Do you have any special requirements we should be made aware of?

Dietary*: Yes No
If yes, please give details:
Medical*: Yes No
If yes, please give details:


Guardian Information

First Name*:
Last Name*:
Gender*: MF
Realtionship to student*:
Email*:
Use same contact info as above (no need to re-type if checked)
Tel (Home)*:
Tel (Work):
Fax:
Home Address*:
City*
State/Province
Zip/Postal Code*:
Country* :


School/College Information (Optional)

Present School/College:
Address:
City:
State/Province:
Zip:



Insurance (please tick one)*

I will purchase the recommended travel insurance from Travel Insurance Center:
I already have comprehensive travel insurance and will forward a copy of the policy within 10 days of this application:


Extras



A deposit of $1000 must be paid within 7 days of this application - if not you will forfeit your place. Please follow instructions after 'Submit' to carry out this payment.
Single Room Supplement - $850: No Yes
I would like to share with (please note this is optional but must be someone of the same sex)
I have read the Terms & Conditions and Rules & Regulations (required)




Now accepting applications!
Reach Cambridge is now accepting applications for Summer 2008!
Reach Cambridge LTD.
Mailing Address: 23 King Street, Cambridge , CB1 1AH, UK
Tel: 1-888-99-REACH (1-888-997-3224)
E-mail: info@reachcambridge.com