2010-11 LIU Dance Audition Registration Form - Long Island ...

2010-11 AUDITION RESERVATION FORM
LONG ISLAND UNIVERSITY-BROOKLYN CAMPUS
PERFORMING ARTS DEPARTMENT
DANCE PROGRAM
TO AUDITION PLEASE PRINT CLEARLY AND RETURN TO:
LONG ISLAND UNIVERSITY,
THE BROOKLYN CAMPUS DANCE PROGRAM
1 UNIVERSITY PLAZA, BROOKLYN, NY 11201
or email your reservation form attached in word format to maryann.wall@liu.edu
or fax the Performing Arts Department at 718-488-1372
FIRST NAME:
LAST NAME:
AGE:
SOCIAL SECURITY NUMBER:
ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE:
E-MAIL:
HIGH SCHOOL:
HS AVERAGE:
COLLEGE (TRANSFER STUDENTS ONLY):
GPA:
EXPECTED DATE OF GRADUATION:
DATE APPLIED TO LIU:
EXISTING OR PREVIOUS INJURY/HEALTH CONDITIONS:
HOW DID YOU HEAR ABOUT THE LIU-BROOKLYN DANCE DEPARTMENT:

PARENT/GUARDIAN FIRST NAME:
PARENT/GUARDIAN LAST NAME:
PARENT/GUARDIAN TELEPHONE:
LIST DANCE TRAINING, BEGIN WITH YOUR MOST RECENT.
SCHOOL TECHNIQUE LEVEL DATES #OF CLASSES
PER WEEK
Select and Circle Audition Date:
November 13, 2010 @ 10 am
February 26, 2011 @ 10 am
May 7, 2011 @ 10 am
Attach a personal essay (typed, 1 page maximum) describing your background in
dance and what you want to do in the dance field when you finish school.
We will confirm your audition slot via email.