Living Routes - Online Application

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79 S. Pleasant St. #A5

Amherst, MA 01002

(888) 515-7333

Welcome! Thank you for your interest in participating in one or more Living Routes' transformational programs. We encourage participants from all backgrounds, learning experiences and interests to apply. We look forward to receiving your application. Please also feel free to call or email us with any questions you may have.

Frequently Asked Questions:

What factors most impact Living Routes' admissions decisions?
Mainly maturity, motivation and a good fit for the program.
Can I apply for Financial Aid at the same time?
You are welcome to submit an application for a needs-based scholarship at any time, but these materials will not be reviewed until after an acceptance decision has been made.
Will delayed references affect my chances of getting accepted to a semester program?
We do not need to wait for references and transcripts to arrive before holding your place for a semester program, but they will be necessary before a formal acceptance can be offered.
What happens after I submit an application?
We will contact you to set up an interview by phone (or in person if you are local).
I would like to participate in two programs. Do I need to apply twice?
Only one application and fee payment ($50) is required if applying to multiple programs. To apply for additional programs use the second and third columns below.

Online Application for Admission

Select Program Country, Term, and Year

Current Contact Information

Full name as it appears on your passport:

First name:
Middle:
Last name:
Preferred name:
Gender:
Social Security Number*:
Cell Phone Number:
Email Address:

Date of Birth:
*Application is submitted over an unsecured connection. SS# can be called in.

Current Address:
Street:
City:
State:
Zip:
Phone Number:
Work Phone Number:
This Address/Landline is valid until:

Permanent Address

Street:
City:
State:
Zip:
Home Phone Number:
Work Phone Number:

Emergency Contact Information

First Name:
Last Name:
Relationship:
Phone Number:
Cell Phone:
Email:

How would you describe yourself?

(This section is optional)

African-American or Black
Native American
Asian/Pacific Islander
Hispanic/Latin American
White (Non-Hispanic)
Multi-Racial
Other (please specify)

Parent/Guardian Information:

Mother/Guardian		Father/Guardian
First Name:		First Name:
Last Name:		Last Name:
Street:		Street:
City:		City:
State:		State:
Zip:		Zip:
Phone Number:		Phone Number:
Email:		Email:
Occupation:		Occupation:

If applying for an International Program, please complete this section:

Do you have a valid passport for the duration of the program, plus 6 months? Yes No
If yes, what is your passport number?* Expiration Date:
*Application is submitted over an unsecured connection. Passport info can be called in.

What nationality is your passport?
U.S. Other:

Please list previous international travel experiences and dates:

If you are currently a student, please complete this section:

Home College or University: GPA:
Present Standing: Fr. So. Jr. Sr. Grad School Other:

Student ID number:
Major(s):
minor(s):

List other educational experiences including institutes, summer programs & foreign studies:
(Include school name, location, grade levels/dates, diploma/degree)
Do you require academic credit from our accrediting university? Yes No

Faculty/advisor approving your off-campus study:

First Name:
Last Name:
Faculty/advisor email address:

What Financial Aid are you currently recieving?
Federal State None Other:

Approximate tuition costs per semester (optional): Room & Board:

Who should we bill for tuition?

Personal Information

How did you find out about this program? (check all that apply)

	Poster
	Fair/Event
	Classroom Presentation
	Friend(s):
	Internet Site:
	Internet Search Engine:
	What was the query?
	Other:

Do you know any others who would like to learn about Living Routes programs?

(name & email)

What is your current profession?
Student
Other

What is your desired or ideal profession?

What is your native language?

Please list any foreign language proficiencies:

Please list some of your activities, interests and passions:

Please describe your community, shared-living, or small group work experience.

Please describe any other relevant experience

Many ecovillages have a spiritual (not religious) focus. How do you feel about this?

Please list three goals/hopes for participating a Living Routes program.

Do you have any ailments, allergies, or physical disabilities that may affect your participation in this program?
No Yes (please specify):

How would you describe your diet?

Please Clarify:

Are you under medical treatment for any reason?
No Yes (please specify):

Are you currently being treated by a psychologist or physician for any emotional, nervous, or mental disorder?
No Yes (please specify):

Do you have any special skills, talents, or experiences you'd like to contribute to the group?

How do you learn best? What are your preferred ways of learning?

Is there anything else you would like to share with us?

Living Routes does not discriminate on the basis of sex, religion, race, color, sexual orientation, national or ethnic origin, physical or mental disability in the administration of its policies and programs.

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Living Routes is an independent, non-profit educational organization with academic programs accredited by the University of Massachusetts Amherst. Living Routes embraces equal employment and educational opportunities for all people. © 2005 Living Routes, All rights reserved. Comments or suggestions to webmaster@livingroutes.org.