Company

Are you a parent or student?

Lead Status

Lead Source

First Name

Last Name

Preferred Name / Nickname

Preferred Email

Mobile Phone (If none, please enter your home phone.)

Preferred Phone

I would like to receive updates from Admissions Staff via text message.

YesNo

Student Information

What is your high school graduation year?

What is the name of the school you currently attend?

If you don't see your school name on the list please type it in the space above.

How did you hear about Maine Coast Semester?

Which Semester Session are you interested in?

Family Information

What is your Student's First and Last Name, and Graduation Year?

(First and Last, Grad. Year)

What is the name of the school your Student currently attends?

If you don't see your school name on the list please type it in the field.

What questions do you have about Maine Coast Semester?

Mailing Address (If completed, we will mail you an information packet.)

Country

Street Address

City

State

State/Province

Zip/Postal Code