Summer Programs Application
Summer 2020: Creative Programs for High School Students
Please select the program(s) you are interested in registering for:
Audio Recording Production
. Grades 9-12.
July 6-24, 2020 - 12:30 PM - 3:30 PM
Digital Photography
. Grades 9-12.
July 6-24, 2020 - 9:00 AM - 11:45 PM
Drawing and Digital Imaging
. Grades 9-12.
July 6-24, 2020 - 9:00 AM - 11:45 AM
Drawing and Digital Imaging
. Grades 9-12.
July 6-24, 2020 - 12:30 AM - 3:30 PM
Filmmaking
. Grades 9-12.
July 6-24, 2020 - 9:00 AM - 4:00 PM
Experimental Filmmaking
. Grades 10-12.
July 27-Aug 7, 2020 - 9:00 AM - 4:00 PM
Musical Theatre Production
.
*
Grades 9-12.
July 6-24, 2020 - 9:00 AM - 4:00 PM
Pre-College Pop/Rock/Jazz Ensemble
. Grades 9-12.
July 6-24, 2020 - 9:00 AM - 11:45 AM
Multimedia Journalism
. Grades 9-12.
July 6-24, 2020 - 9:00 AM - 4:00 PM
*
Performances to be held at 7:30pm on July 24 & 26
Student Personal Information
Name
*
First
Last
Gender
Male
Female
Permanent Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Is your mailing address the same as the address above?
Yes
No
Mailing Address
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Home Telephone
*
Student Cell Phone
Parent Daytime Phone
Email Address
*
School Information
This fall, I will be in the following grade:
*
Please select
9th
10th
11th
12th
Other
Please enter the grade you will be in this fall.
School Name
*
School Location
City
State / Province / Region
Emergency Contact
Emergency Contact Name
First
Last
Emergency Contact Phone
Relationship
(ie. Mother, Father, Grandmother, etc.)
Instructions
INSTRUCTIONS:
After submitting this Summer Application form, please submit your full payment to:
SUMMER PROGRAMS, FIVE TOWNS COLLEGE, 305 North Service Rd., Dix Hills, NY 11746. Checks are to be made payable to: Five Towns College. If enrolling for more than one program you may combine your tuition payment.
TUITION PAYMENTS
: Can be made in 2 equal installments, following this time schedule or paid in full at the time of registration. If enrolling for more than one program you may combine your tuition payment.
LUNCH:
For an additional $160 you may purchase Lunch Plan.
DEADLINE:
Submit the Application and Tuition no later than June 26, 2020.
TRANSPORTATION:
You are responsible for your own transportation to the College. The Suffolk County Bus S-23 comes on campus, leaving from the Babylon LIRR Train Station, Wyandanch LIRR Train Station, and the Walt Whitman Mall.
CALENDAR:
Most classes start July 6, 2020.
MUSICAL INSTRUMENTS:
The student is responsible for providing their own musical instrument.
NOTE:
By participating and/or performing in the Summer Program, students and their parents’ consent to the inclusion of their photograph, likeness or recording for promotional or advertising purposes.
Application Agreement
*
I certify that all information provided is accurate and complete.
Name of Student
First
Last
Signature of Student
Name of Parent or Guardian
First
Last
Signature of Parent or Guardian
Date: 05/07/2025
