Top Navigation

PEEPS application form

Thank you for your interest in Cornell Plantations' PEEPS program! Please fill out this application form and submit by February 24th (returning students) and March 7th (new students). In addition to this online form, we must also receive a signed commitment pledge and two reference forms.

Download the commitment pledge.

Download the reference form.

Contact Donna Levy at dl51@cornell.edu, or 254-7259 with any questions.

Contact Information
Parent/Guardian #1
Parent/Guardian #2
Emergency Contact

If you answered yes, PLEASE ANSWER THE TWO QUESTIONS BELOW, THEN SUBMIT YOUR APPLICATION (please note: A commitment pledge is still required but references are not necessary).

If you answered no, PLEASE ANSWER THE SHORT ANSWERS FOR NEW APPLICANTS.

Short answers for returning PEEPS

Please submit your application. (Note: A commitment pledge is still required but references are not necessary).

Short Answers For New Applicants
About You
Program Expectations
Ideas for the Future
By submitting this form, you accept the Mollom privacy policy.