College Expedition USA Student Application Fall 2019

Completion of this application will allow you to be considered to participate in College Expedition USA this fall. College Expedition USA will host three expeditions around the United States this fall, and you may use this application to apply to one or multiple expeditions. Information for this fall's expeditions can be found below. Note that all schools are TENTATIVE.

College Expedition D.C. & Philadelphia (Oct. 3-6): Georgetown, George Washington, University of Pennsylvania (UPenn), Johns Hopkins, University of Virginia (UVA)

College Expedition Southern California (Oct. 10-13): Harvey Mudd, Pomona, Loyola Marymount, University of Southern California (USC), University of California Los Angeles (UCLA), and a special visit to a large technology company

College Expedition Atlanta/Raleigh-Durham (Oct. 24-27): University of Georgia (UGA), Emory, Georgia Tech, Duke, University of North Carolina (UNC)

Application deadline is Sunday, August 4th at 11:59pm PST.

Your application will only be considered for the expeditions you select below. It is NOT necessary to fill out the application more than once if applying to multiple expeditions.

All questions are required.

Applications are on-going. Applications submitted after the listed deadlines cannot be considered for that expedition.

Please note that you must currently be in 9th-12th grade to be eligible to apply for trips in the fall. Community college/junior college students may be considered.

Students will be informed of decisions by August 31st.

By completing this form, you hereby consent to the collection, use, storage, transfer, and processing of your data by His Highness Prince Aga Khan Shia Imami Ismaili National Council for the United States and its affiliates for the limited purpose of developing, delivering, and evaluating programs and services offered by the Council and its affiliates.

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Name Name * First Last
Gender *
Date of Birth Date of Birth * / MM / DD YYYY
Student Email Address *
Student Cell Phone Number Student Cell Phone Number * - ### - ### ####
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Region *
Parent/Guardian Name *
Parent/Guardian Email Address *
Parent/Guardian Cell Phone Number Parent/Guardian Cell Phone Number * - ### - ### ####
Health Insurance Provider *
Health Insurance Policy ID *
Please list any Allergies, Medication and/or Dietary Restrictions
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