Class Registration Form

Class Registration Form

University Program for Au Pairs at C.W. Post

Part I. The C.W. Post Campus of Long Island University is pleased to provide educational programs that Au Pairs may

attend to fulfill their credit requirements. These courses are open to Au Pairs and all interested students. This program

provides an opportunity for students to participate in a few options on the C.W. Post Campus. During the summer semester overnight accommodations will be on campus. During the fall semester overnight accommodations will be offered at the East Norwich Inn. For the students living close to campus we are offering a commuter plan.

Please select from the Following Courses:

Fall 2009 Semester

Growing Up In AmericaOctober 2-4, 2009

Storytelling: As A Way of Life: Exploring Traditions October 2-4, 2009

History of American MusicOctober 2-4, 2009

TOEFL/ English Preparation CourseOctober 16-18, 2009

American Indian Cultures and Their Impact on October 16-18, 2009

American Society

Government and Politics October 16-18, 2009

History of American Women – American History November 20-22, 2009

History of American MusicNovember 20-22, 2009

American Indian Cultures and Their Impact on November 20-22, 2009

American Society

Highlights of the Harlem RenaissanceDecember 4-6, 2009

TOEFL/ English Preparation CourseDecember 4-6, 2009

History of American MusicDecember 4-6, 2009

Storytelling: As A Way of Life: Exploring Traditions December 11-13, 2009

Growing up in AmericaDecember 11-13, 2009

Celebration of Holidays – American CultureDecember 11-13, 2009

Au Pair Name:Date:

CANCELLATION POLICY

If you cancel ………

7-14 days before the course you will receive 75% back of the tuition

6 days 50% back of the tuition

Start date of the course there will be no refund

There will be no refund if you do not attend a course

Switch a course to a different semester as long as it doesn’t fall within the cancellation policy-$25

Part II.

Au Pair Name

(Please Print)(Mr. or Ms.)(First name)(Last Name)

MaleFemale

Au Pair U.S. Address (Street)

(City)(State)(Zip)

Home # Cell # Email

Au Pair Home Country Au Pair Company

Host Family Name Date started as Au Pair

(Month / Year)

Have you previously taken a course with us? / Yes / No

Please choose from the following options:

Commuter Plan—4 meals, class materials, and three credits for a total of $250 NO Hotel Accommodations

Fall Resident Quad Occupancy Plan—4 Aupairs to a room, with 2 full size beds, 6 meals,

class materials and three credits for a total of $350 per person

Fall Resident Double Occupancy Plan—2 Aupairs to a room, with 2 full size beds, 6 meals,

class materials and three credits for a total of $450 per person

*Please notify us at check in who you would like to room with.*

Part III. PAYMENT MUST BE ENCLOSED WITH THIS CLASS REGISRATION FORM.

Payment Options - Please select one of the following payment options:

By Check or Money Order – Payment of $ for class (es).

Make checks payable to Long Island University.

By Credit Card – Payment of $ for class (es).

should be charged to the following credit card:

Card holder’s Signature

Card holder’s Name

Credit Card Type  Visa  MasterCard  Discover  Amex

Card Number

Expiration Date/ CSC #

M Y

To register by telephone with a credit card please call Anne Schubeck or Victoria DiBenedetto at (516) 299-2359

E-mail us at or fax us your application form to (516) 299-2363

Please return form with payment to:

University Program for Au Pairs

C.W. Post Campus/Long Island University

720 Northern Blvd. Brookville, New York 11548