Applicant's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Has your child applied to Eaglebrook for the regular school year?

Yes

No

Guardian's Name *

First Name

Last Name

Check all that applies

Parents divorced

Parents separated

Mother deceased

Father deceased

Child adopted

I wish to enter my child in the following year of the Global Leadership Program, in accordance the policies listed *

2024

In consideration of the undertaking by the Sponsors of the Global Leadership Program (ConnectEd U Co., Ltd.) to process the undersigned candidate's application for admission and related forms, you agree that the information furnished on the Registration form, together with all the information and materials of any kind received by the company from any source, or prepared by anyone at its request, shall be completely confidential and shall not be disclosed to anyone, including the candidate and his or her family, except that the company may, for official purposes at their discretion, disclose any part or all thereof to such person or persons as they deem advisable. *

I agree

I disagree

Name of Person Submitting Application (if not Applicant's Parent or Applicant)

First Name

Last Name