Immerse: Youth Discipleship Academy

Student Information

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Phone*

Email*

T-shirt size*

Expected High School graduation date*

Gender*

Male Female

Ethnicity (optional)

Race (optional)

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Choose as many as apply

Home Church*

Please write “N/A” if none

Name of Pastor or Youth Pastor*

Please write “N/A” if none

Email address of Pastor or Youth Pastor*

Please write “N/A” if none

Dietary Restrictions/Food Allergies*

Please write “N/A” if none

Payment Options

Tuition and Scholarship Policies (please read carefully)

Your spot at Immerse 2021 is reserved only once we receive a $100 deposit.
All deposits are non-refundable.
We are pleased to be able to offer limited scholarship funds on an as-available basis. Scholarships aid is not guaranteed.
To apply for scholarship aid, please visit our scholarship application. No deposit or reservation is necessary to apply for a scholarship. We will be in touch with you to discuss different funding options as available. Please note that your spot is not guaranteed without a deposit or until a scholarship is granted, whichever comes first.
Through April 30, 2021, scholarships will be considered for first-time Immerse students only. Beginning May 1, 2021, returning Immerse students may be considered for scholarships pending availability of funds. However, first-time and returning Immerse students may apply for scholarships at any time.
All students are encouraged to approach their local church, friends, and family members about financial support. Please see our sample letter to church leaders and our sample letter to friends and family members for ideas.

I Agree*

I have read and understand the Tuition and Scholarship Policies. I understand that all deposits are non-refundable, even if I request a scholarship.

Tuition for Immerse 2021 is $200 for Hybrid participants, and $100 for All-Virtual participants.

Amount*

Apply for Immerse scholarship aid. Hybrid Participants: Pay $100 non-refundable deposit or $200 non-refundable tuition in full and reserve my spot at Immerse 2021. All-Virtual Participants: Pay $100 non-refundable tuition in full and reserve my spot at Immerse 2021.

Amount that I am able to pay* $

Amount I’m depositing now* $

Would you be willing to ask your church for financial support?*

Yes No

Would you like to receive personal fundraising ideas?

Yes No

Please describe the reason you are asking for a scholarship?*

We will contact you about your scholarship request. Scholarships are not guaranteed. The full $868 tuition must be accounted for prior to attendance.

Total $

Quikpay Status

Quikpay Confirmation Number

Thankyou Page

Department Email

Quikpay Order Type

Quikpay Order Description

Form ID

FOA Code

Student Information

Parent/Guardian Information

Payment Options