High School Summer Programs
Southampton Graduate Campus of Long Island University
239 Montauk Highway
Southampton, New York 11968

• I am applying for the following high school workshop (s):
  ___Young Writers Workshop
  

• First Name:

• Last Name:

• Address:

• City/State/Zip:

• Phone (with area code):

• Gender: ___Female ___Male

• Date of Birth:

• Social Security:

• High school currently attending:

• Expected year of high school graduation:

• Parent/Guardian Signature:

• Student signature:

• Do you have any dietary restrictions?
  ___Vegetarian
  ___Vegan
  ___Alergy:
  ___Other:

• Would you like to room with someone from your home area or a friend?
  ___Yes ___No
  (If a friend, please fill in his or her name. Both parties must request to house together to fulfill the request.):

Please include with this application a copy of your high school transcript, PSAT/SAT scores, or ACT scores, and an essay (no more than five pages, approx. 1250 words) on a topic related to the program for which you are applying.

SUMMER HOME