Class Registration Form
University Program for Au Pairs at C.W. Post/Long Island University
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 America October 2-4, 2009
Storytelling: As A Way of Life: Exploring Traditions October 2-4, 2009
History of American Music October 2-4, 2009
TOEFL/ English Preparation Course October 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 Music November 20-22, 2009
American Indian Cultures and Their Impact on November 20-22, 2009
American Society
Highlights of the Harlem Renaissance December 4-6, 2009
TOEFL/ English Preparation Course December 4-6, 2009
History of American Music December 4-6, 2009
Storytelling: As A Way of Life: Exploring Traditions December 11-13, 2009
Growing up in America December 11-13, 2009
Celebration of Holidays – American Culture December 11-13, 2009
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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)
Male Female
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?
0 Yes
0 No
Please choose from the following options:
o Commuter Plan—4 meals, class materials, and three credits for a total of $250 NO Hotel Accommodations
o 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
o 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 o Visa o MasterCard o Discover o 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 aupair@cwpost.liu.edu 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
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