2022 Summer THEA Institute Application

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Applicant Information

First Name

Middle Name

Last Name

Preferred name

Personal Phone Number

Email Address

Confirm Email Address

Birthdate

Gender

Permanent Address

Address

Country

Street

City

Region

Postal Code

Ethnicity (optional)

Are you of Hispanic or Latino descent?

Yes

No

Parent or Guardian 1

First Name

Last Name

Relationship to you

Street Address

City

State or other Region

Postal Code

Country

Phone Number

Email Address

Parent or Guardian 2

First Name

Last Name

Relationship to you

Phone Number

Email Address

High School Information

Look up high school

High School Code
International students may enter "INTL HS" as a code

Cumulative high school GPA and GPA scale: (example: 3.5 out of 4.0)

What year will you be in Fall 2022?

Application Questions

Please list three activities that you currently participate in with a brief description of each.

Activity 1:

Activity 2:

Activity 3:

In 200-300 words, please explain why you would like to attend THEA.
Please note that this website will not save your progress. It is recommended that you draft your response in a Word or Google Doc, and copy and paste it here when it is finalized.

How did you hear about THEA?

As part of the daily schedule, there will be a music group that will assist with different events. Would you be interested in being part of this group?

Yes

No

What instrument do you play?
If you are interested in singing in this group, please write "Vocalist" in the box below.

T-Shirt Size

Religious Preferences

Other:

Name of Parish/Congregation:

Miscellaneous

Have you ever been dismissed, suspended, or placed on probation for student judiciary or disciplinary matters?

Yes

No

If yes, please use the box below to provide an explanation.

Have you ever been dismissed, suspended, separated from school, or placed on probation for academic reasons?

Yes

No

If yes, please use the box below to provide an explanation.

Have you ever been charged and/or convicted of a crime other than a misdemeanor or traffic violation? Or, are there any pending charges against you other than a misdemeanor or traffic violation?

Yes

No

If yes, please use the box below to provide an explanation.

Reference

Please provide the name and contact information of a character reference below. This person should not be related to you, but they may know you in a personal way (ex: family friend). Teachers, coaches, and supervisors are all wonderful options. Please inform your character reference that you are providing their information and that they may be contacted by the THEA team.

Name

Phone Number

Email Address

Certification

I understand that all confidential recommendations connected to this application will be used solely to evaluate my application, and will not be disclosed to anyone, including myself.

I understand that the THEA Institute is a pre-college summer program. As a participant, I represent my school, my family, and myself while on Loyola University Chicago's campus.

I certify all information in my application is accurate and my own work. I authorize the verification of my credentials for admission. I understand and agree that any misrepresentation or omission of facts in my application will justify the denial or the rescission of admission. If I am admitted, I will comply with all the rules, regulations, and policies of Loyola University Chicago, and that my admission, matriculation, and graduation are subject to the control of the authorities of Loyola University Chicago.

I certify that Loyola University Chicago may publish, for public relations and marketing purposes, my photograph, or photographs and videos in which I appear.

I understand that if I'm accepted into the Loyola University Chicago's Theology of Healing Earth in Action (THEA) Institute, I must commit and agree to participate the entire week of the program.

Yo entiendo que todas las recomendaciones confidenciales relacionadas con esta solicitud se utilizarán únicamente para evaluar mi aplicación y no se divulgarán a nadie, incluido yo mismo.

Yo entiendo que el instituto de THEA es un programa de verano preuniversitario. Como participante, represento a mi escuela, a mi familia y a mí mismo mientras estoy en el campus de la Universidad Loyola de Chicago.

Yo certifico que toda la información en mi solicitud es correcta y es mi propio trabajo. Autorizo la verificación de mis credenciales para la admisión. Entiendo y acepto que cualquier tergiversación o omisión de hechos en mi solicitud justificará la denegación o la rescisión de mi admisión. Si soy admitido, cumpliré con todas las reglas, regulaciones y políticas de Loyola University Chicago, y que mi admisión, matriculación y graduación están sujetas al control de las autoridades de Loyola University Chicago.

Yo certifico que Loyola University Chicago puede publicar, por razones de relaciones públicas y marketing, mi fotografía o fotografías y videos en los que aparezco.

Yo entiendo que si soy aceptado al Instituto de Teología de Sanando la Tierra en Acción (THEA) de la Universidad Loyola de Chicago, debo comprometerme y aceptar a participar durante toda la semana del programa.

In place of your signature, please type your full legal name:
En lugar de su firma, escriba su nombre legal completo:

Signature

Date