MOUNT HOLYOKE COLLEGE, South Hadley, MA, July 8th - 22nd, 2007
Philosophy | P.L.A.Y. Program | People Behind P.L.A.Y. | The Details | Application Form

APPLICATION FORM

Please print this application and mail with completed health form to:
P.L.A.Y. INC., c/o Dennis Jackson
P.O. Box 1345
Amherst, MA 01004-1345
(413) 585-0549
Enrollment acknowledgement will be sent upon receipt of this application
APPLICATION DEADLINE: May 18, 2007 by 5:00p.m.
Name:
Phone (including area code):
Address:
City:
State: Zip:
Height: Weight:
Date of Birth:
Name(s) of parent(s) or guardian(s):
High School:
Name(s) of guidance counselor(s):
School Address:
City:
State: Zip: Phone No:
High School Major: College Prep Business General
High School G.P.A.:
Class Rank: in class of
P.S.A.T. Scores: Verbal Math
A.C.T. Composite Score:
S.A.T. Score: Verbal Math
Date of Graduation:
Student Signature: Date
Parent's or Guardian's Signature: Date

(Signature of parent or guardian is mandatory if student is under 18 years old.)

A $50.00 non-refundable fee is required for processing