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School of Theatre Student Application Form

 
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Student Information

First Name:*

Last Name:*

Current Grade:*

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:

How did you hear about the program:

Parent/Guardian's Information

First Name:*

Last Name:*

Primary Phone:*

Alternate Phone:

Email:*

Please provide the parent/guardian address if different from the student.

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:

In addition to submitting this online form, the applicant acknowledges that the submission of a video audition is required. Detailed information and requirements can be found at http://www.oce.nysed.gov/nysssa/theatre*
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