305 North Service Road Dix Hills, New York 11746-5871 Tel: (631) 656-2110 Fax: (631) 656-2172 Email:


I am applying for the workshop(s) or classes in:

JULY 5 – 22, 2011
9:00AM – 12:00AM Audio Recording Theory (College Credit) Digital Photography Guitar Workshop 9:00AM – 4:30 PM Filmmaking I 12:30 PM – 4:00PM Audio Recording I

JULY 25 – AUGUST 12, 2011
9:00AM – 4:00PM Filmmaking II 12:30 PM – 3:30PM Audio Recording II

PERSONAL INFORMATION Name Last Permanent Address Number and Street - Apt. Mailing Address (if different than above) Home Telephone ( ) ) Student Cell Phone ( Email Address Town ) State Zip First Middle Male Female

Parent Daytime Telephone (

HIGH SCHOOL INFORMATION This Fall I will be considered a High School Address Town School Telephone ( ) Guidance Counselor State Zip Sophomore Junior Senior Date of Graduation

APPLICATION PROCESS Submit all of these documents at the same time. INSTRUCTIONS: Complete this Summer Application form and send it with your tuition deposit to: SUMMER WORKSHOPS Five Towns College 305 North Service Rd. Dix Hills, NY 11746 TUITION & DEPOSIT: Please attach your deposit check made payable to: FIVE TOWNS COLLEGE based upon the following workshop programs. If enrolling for more than one program you may combine your tuition deposit. SESSION 1: JULY 5 TO JULY 22, 2011 (3 weeks)
Program Filmmaking I Audio Recording Theory (College Credit) Digital Photography Guitar Workshop Audio Recording I Tuition $1,700 $1,275 $850 $850 $850 Deposit $550 $300 $300 $300 $300

SESSION 2: JULY 25 TO AUGUST 12, 2011 (3 weeks)
Program Filmmaking II Audio Recording II Tuition Deposit $1,700 $550 $850 $300

Note: Session 1 - Balance of Tuition is due by June 24, 2011. Deposits are refundable up to June 17, 2011. Session 2 - Balance of Tuition is due by July 15, 2011. Deposits are refundable up to July 11, 2011. LUNCH: For an additional $100 you may purchase a 3 week Lunch Plan. DEADLINE: Submit all Applications and Full Tuition for Session 1 no later than June 4th and by July 9th for Session 2. TRANSPORTATION: You are responsible for your own transportation to the College. The Suffolk county Bus S-23 leaves from Babylon train station and the Walt Whitman Mall to Five Towns College. MUSICAL INSTRUMENTS: The student is responsible in providing their own musical instrument. COLLEGE CREDIT COURSES: Student must purchase course textbook which is available online. NOTE: All photographs or videos taken during the High School Summer Workshops may be utilized in future college promotions. I certify that all information provided is accurate and complete. Signature of Student Signature of Parent or Guardian Date Date

The College complies fully with the provisions of Title IX of the Education Amendments Act of 1972 and does not discriminate on the basis of sex, age, race, nationality, religion, physical handicap, or marital status in its education programs or activities. Any grievance relating to this policy may be presented to the College's Affirmative Action Officer.
Five Towns College is accredited by the Middle States Association of Colleges and Schools and the New York State Board of Regents.

Sign up to vote on this title
UsefulNot useful