Application for Admission

How to apply: Please e-mail (silverberg@alum.mit.edu) or call (520-245-3711) before applying to be sure there is still space available on the course. Please mail completed forms to: Admissions, Environmental Learning Institute, PO Box 3727, Tucson, AZ 85722 USA

1. Print out forms from the website. Complete the Application Form below.
2. Give the Reference Form to a teacher/professor or academic advisor who is well acquainted with you and your academic performance.  Ask them to complete it and return it to you. 
3. Mail the Application Form and Reference Form to Admissions, Environmental learning Institute, PO Box 3727, Tucson, AZ 85722 USA. You will be notified of your acceptence within 2 days of our receiving the forms.

Once accepted:

You need to pay your non-refundable course fee deposit. This $300 non-refunadable deposit is due within 10 days of being accepted in the course. Please write your $300 fee deposit check to Environmental Learning Institute, mail it to Dr. David Scott Silverberg, ELI, PO Box 3727, Tucson, AZ 85722 USA.

After you have paid your fee deposit:

1. Please give the Medical Form to your health care provider.  Ask them to complete it and return it to you. 
2. Complete the Informed Consent Form.
3. If applying for the $500 financial aid scholarship, complete the Financial Aid Form.
4. Include a photocopy of the information page of your  passport (or original birth certificate).
5. Include a photocopy of your health insurance card and include the insurer’s phone number.
6. Secure permission to participate from your school, if necessary.
7. Mail the forms to Admissions, Environmental learning Instiute, PO Box 3727, Tucson, AZ 85722 USA.

Please pay any outstanding amount of the course fee by the specific course's full fee due date. Thank you.

Personal Information

Name:

Social Security Number (if applicable):

Birthdate:

Mailing Address

Street:

City:

State:

Zip Code:

Phone:

E-Mail:

Permanent Address

Street:

City:

State:

Zip Code:

Phone:

E-Mail:

I am applying to the following Course

Title:

Dates:

Are you applying for financial aid?

Passport/Birth Certificate Information: You will need a passport to travel in Thailand, Nepal or Mexico.

Do you have a passport?

What is the number?

What is the expiration date?

Do you have an Official Copy of your Birth Certificate?

Health Insurance Information

My health insurance company is:

My health insurance policy number is:

The phone number for my health insurance company is:

Will your health insurance cover you overseas?

Education

College/University Name:

Major (actual or intended):

Date of Graduation:

Science Courses Taken:

Additional Information

Name of Parent(s) or Guardian or Spouse or person to contact in case of an emergency:

Telephone #:

Parent’s Address:

Experience and Interests

Extracurricular activities/clubs or organizations:

Off-campus study programs in which you have taken part:

Outdoor/camping experience:

Backpacking experience:

Travel experience (when, where, with whom, how long):

Career plans (if known):

I have read the Environmental Learning Institute course description, syllabus, proposed itinerary, personal equipment list, personal clothing list, informed consent form.  I feel that I understand and would enjoy and benefit from the academic experience they describe.  I certify that all information I have provided on this form and in the other required forms are correct and accurate to the best of my knowledge.

Applicant signature:

Date: