In addition to this online form your application will require:

  • Non-refundable $35 ($50/couple) application fee. (Pay online)
  • Signed Release, Consent for Treatment and Emergency Contact Information forms.

Download Online Application Supplement Forms Adobe PDF
(Includes: Release of Liability, Consent for Treatment and Emergency Contact Information Forms.)

Please note: This online application form is not compatible with all web browsers. If you are having trouble please submit your application via mail.

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Personal Information
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  3. Sex
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Contact Information
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  2. Due to technical issues we cannot accept "hanmail" or "naver" email addresses. Please use another email account like GMail.
  3. (required)
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Personal Questions
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Physicians Reference
  1. For your application to be completed and processed you must also have a physician fill out and mail a physician's reference form directly to us at:

    Youth With A Mission
    Attn: Applications
    1275 Birch Road
    Lebanon, PA 17042
  2. (required)
Application Fee
  1. For your application to be completed and processed you must pay the non-refundable application fee of $35 USD for an individual or $50 USD for couples. You can pay instantly online or send a check, made out to "Youth With A Mission" to us at:

    Youth With A Mission
    Attn: Applications
    1275 Birch Road
    Lebanon, PA 17042
Legal
  1. For your application to be completed and processed you or your parent(s)/legal guardian(s) must sign our "Consent For Treatment", "Release of Liability" and "Emergency Contact Information" documents. (Download link at top of page.) Check the box below to indicate that you have signed them and are sending them to us at:

    Youth With A Mission
    Attn: Applications
    1275 Birch Road
    Lebanon, PA 17042
Finally...
  1. We're glad that you've decided to apply for ESL, please remember that you are not accepted to the school until you receive a letter or phone call from us indicating your acceptance. Also, the full tuition fees are due the first day of class unless prior arrangements have been made and confirmed before your arrival.
 

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Please note: This online application form is not compatible with all web browsers. If you are having trouble please submit your application via mail.