Pacific Discovery | Program Application Forms

Education Information

Step 4 of 8
School year when joining program*
High School you graduated from or are currently attending*
University you attend or are confirmed to attend. If not confirmed or not in school write 'NA'*
Optional college credit may be available. Are you interested in earning credit on your program?*

YesNoUnsure

Parent or Guardian Contact Information

Step 6 of 8
Primary parent or guardian name*

First NameLast Name
Primary parent or guardian phone number*

Country CodeArea CodePhone Number
Primary parent or guardian email*
example@example.com
Primary parent or guardian relationship to you*
Primary parent or guardian address*

Street Address

Street Address Line 2

City / SuburbState / Province / Region

Postal / Zip Code
Primary parent or guardian country*
Secondary parent or guardian name

First NameLast Name
Secondary parent or guardian phone number

Country CodeArea CodePhone Number
Secondary parent or guardian email
example@example.com
Secondary parent or guardian relationship to you
Secondary parent or guardian address

Street Address

Street Address Line 2

City / SuburbState / Province / Region

Postal / Zip Code
Secondary parent or guardian country
Important email correspondence with you is CC’d to your Primary parent / guardian. Would you like correspondence CC'd to your Secondary parent/guardian as well?

YesNo

Financial Aid

Step 7 of 8
Would you like to apply for any of the following scholarships? Select all that apply

Diverse Voices ScholarshipGap Year Ambassador FellowshipFinancial Need ScholarshipExploration Scholarship
Please note, you must meet all requirements to be eligible for the scholarship/s you select. You will not be considered until you submit your scholarship application to info@pacificdiscovery.org.

You can find more information on our finanical aid and scholarships page here.
How Did You Find Pacific Discovery?
Please let us know how you found us*
Please state the name and location of the event (ie: Gap Year Fair at _ High School, College Fair at _ High School, Alternative to College Fair, etc.)
Advisor or Educational Consultant Name
Word of Mouth Referral Name
Who found us?*

Student Information Continued