Elms College Iceland Spring Break Registration Form First Name * Last Name * Date of Birth * MM DD YYYY Phone Number * (###) ### #### Street Address * City * State * Zip Code * School Email Address * Race/Ethnicity * Please select all that apply American Indian or Alaska Native Asian or Indian or Philippines origin Black or African American White or Northern European Native Hawaiian or Pacific Islander Multi-racial or other Middle-Eastern origin Hispanic or Latino/Latina Gender * Female Male Transgender (unspecified) Other College/University Graduation Year * Have you travelled internationally? * Yes No Country of Citizenship: What is your passport status? * Please note- if you are not a US passport holder please inform the Compass staff immediately as you may need a visa to travel to Iceland and/or to return to the US. Current- US Current- non-US Current- Expiring soon (<6 Months) Current- non-US Expiring Soon (< 6 months) Expired None Passport Expiration Date MM DD YYYY Parent/Guardian Name * Put N/A or information for applicant if independent First Name Last Name Parent/Guardian Phone * Put N/A or information for applicant if independent (###) ### #### Parent/Guardian Email * Put N/A or information for applicant if independent Thank you!
