Summer 2016 ESL Institute
Cultural Trips Application
NAME: _______________________________________________________________
(Name as it appears exactly in your passport – please print or type)
ADDRESS: _____________________________________________________________
CITY: ______________________________ STATE: ______ ZIP: _______________
DATE OF BIRTH: ______________________________________________________
CELL PHONE NUMBER: ______________________________________________
E-MAIL: _______________________________________________________________
(Please print clearly)
DATE OF BIRTH: _______________________________________________________
GENDER: MALE _______ FEMALE _______
SUMMER SESSION 2_______
WILL YOU BE LIVING ON CAMPUS? YES_______ NO ________
TRIPS COST – to be determined
Cultural trip fees include housing, transportation and a guide of historical and cultural sites in:
Bethlehem/Easton (Daytrip)
Philadelphia (Overnight)
Washington D.C (Overnight)
New York City (Overnight)
Local excursions
The fee does not include the cost of meals. Participants are responsible to pay for their own food
while on the cultural trips.
DEPOSIT OF FUNDS
Payment of fees must be made to NCC’s Bursar’s office to the International Student Travel
Account, Account # 20-2258-4124-SESL. Please see attached wire transfer or Credit card
payment forms.
CANCELATION AND REFUND POLICY
NCC reserves the right to apply refunds against outstanding past-due balances owed to the
college. Participants must inform NCC in writing if they choose to cancel their participation in
the program. All correspondence should be addressed to NCC, Center for International
Education, 3835 Green Pond Road, Bethlehem, PA 18020, phone, or email. Please be aware that
NCC is required to make various deposits to reserve accommodations, transportation, etc. For
this reason, no refunds will be given on fees already received. If student does not pay in full for
program, a hold will be placed on his/her account and will not be released until all fees have
been paid.
_________________________________________________________
Applicant Signature
Date
Please return form to
Center for International Education
3835 Green Pond Road,
Bethlehem, Pennsylvania 18020
Or email it to SummerESL@northampton.edu