PENOBSCOT SCHOOL
28 Gay Street, Rockland, Maine 04841 USA
Tel: 207 594-1084 Fax: 207 594-1067

SUMMER ENGLISH COURSE APPLICATION
You may fill out this form online or print and fax it.
Application for:  
Your name:




Mailing address:    
City and state: Country:
e-mail:
Tel number: (day)  
Date of Birth: Place of Birth:
Citizenship:
Your native language:
Married?
Other languages you speak:  
Please give us some details about your education, your work experience, and your work today:  
Please tell us as much as you can about your hobbies and special interests. Is there anything in particular you would like to do while you are in Rockland?
Please provide some details of your history of English study and please evaluate your level of English ability:  
Do you have any special dietary requirements, physical limitations, health problems, or other special conditions? If so, please explain.  
Some homestay hosts have children, some have cats or dogs. Do you have any preferences?  
Do you smoke?
yes no
Do you have a driver's license? yes no
Please add any other information about yourself that would help us select your homestay host:
How did you learn about Penobscot School?:
Finally, we need to know that you understand and accept two important features of the English program at Penobscot School:
1. It is a total English language immersion, 24 hours a day, every day, for three weeks. Students are asked to speak only English with each other, teachers, hosts, and with the locals. To maintain the true immersion, students are asked to limit to a bare minimum their contact with home and job via telephone, email or the Internet. All classes are taught entirely in English. You must already be able to speak English at an intermediate level.
2. It is a cooperative community of students, teachers, home-stay hosts and other volunteers. We have no servants. At school and their home-stay, students help with meal preparations, family style.
I understand and agree to the above.
Date of application:


Note re: your photograph
A photograph is not required for this application. If you have one that you can send, (by regular mail or as an attachment to this email) it will help us to introduce you to your home-stay host and to recognize you when you arrive.