School of Theatre Application: NYSSSA : OCE : NYSED

New York State Summer School of the Arts

Experience it Yourself

School of Theatre Student Application Form

Student Information

First Name :
Last Name:
If different from your legal name, what name do you go by?
Age:
Date of Birth: (mm/dd/yyyy)
Gender:
Student's Cell Phone:	( ) -
Student's E-mail:
Address 1:
Address 2:
City:
State:
Zip Code:
County:
Current Grade:

Parent/Guardian's Information

First Name:
Last Name:
Home Phone:	( ) -
Cell Phone:	( ) -
E-mail:
	Check this box if Student Address and Parent Address are the same.
Address 1:
Address 2:
City:
State:
Zip Code:

I, the parent/guardian of the above named student, consent to the release of the information on this application to NYSSSA. I authorize NYSSSA to use my student's name in association with any news releases, and permit the use of any photographs, digital images or videos taken during the audition for publicity or documentation purposes.

School Information

School Name:
Principal's Name:
School Phone:	( ) -
School Address:
City:
State:
Zip Code:
Drama Teacher:
Drama School Phone:	( ) -
Drama School E-mail:

I request mailed copies of NYSSSA correspondence
(Please note: All student application correspondence will be emailed to the student and parent email address provided above)

Cultural Education

New York State Archives, Library, Museum and Public Broadcasting

New York State Summer School of the Arts

Experience it Yourself

School of Theatre Student Application Form