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Please return along with the completed Student Health Form by March 1, 2010. Please read the Conditions section carefully before submitting your application. 

WIESCO, INC. STUDENT APPLICATION

Name (last, first, middle initial):____________________________Date:_____________

Street Address: ___________________________________________________________
City, State, Zip____________________________________________________________
Phone number (s): _____________________________ E-mail address: _______________

The student participants in WIESCO, INC. sponsored programs must be 15 to 18 years old. A parent, who is a teacher or another sponsoring teacher delegated by the parent, must be at the same language camp.
EDUCATION BACKGROUND:
1. High school grade completed? _______________

2. Name and address of your high school: _____________________________________

_____________________________________________________________________

3. List the extracurricular activities in which you participate:
______________________________________________________________________
______________________________________________________________________

4. List your hobbies/activities: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

PLEASE RANK YOUR PREFERENCE OF PLACEs TO PARTICIPATE:

______ Poland – Torun:
______ Latvia – Daugavpils:
______ Lithuania – Plunge:

STATEMENT OF INTEREST: Please provide a letter giving your reasons why you wish to join our program and why you are interested in participating in the program of your choice.
REFERENCES: Please provide a letter of reference and recommendation from the following
persons. Please include these letters with your application:
1. a parent/s 2. two teachers.

AUTHORIZATION: I certify that the facts in this application are true. I authorize investigation of all statements contained herein and the references listed above to give any information concerning my character.
Student Signature:________________________________________ Date: _______________
PARENTAL AUTHORIZATION: I hereby grant permission for my daughter/son
____________________________________
(name)
to participate in the WIESCO, INC. program.
Parent (s)signature (s): __________________________________________________
Please send with the application: $200.00 registration fee and a RECENT PICTURE of yourself, and your Health Form. Return your completed Application and Health Form by March 1, 2010.

TO: WIESCO, INC.
15065 Shoreline Drive
Merrill, WI 54452