UPNS APPLICATION
Child's Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
Gender
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian(s):
Parent/Guardian #1 Name
*
First Name
Last Name
Email
*
example@example.com
Cell Phone Number
*
-
Area Code
Phone Number
Occupation
*
Work Address
Business
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian #2 Name
First Name
Last Name
Email
example@example.com
Cell Phone Number
-
Area Code
Phone Number
Occupation
Work Address
Business
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a currently affiliated with NYU as faculty, student or staff?
*
Yes
No
If so, in what capacity?
Does the applicant have siblings?
*
Yes
No
If so, please list their names and ages here:
Is the applicant a sibling of an alumni?
*
Yes
No
Please list any prior group/school experience the applicant has had:
*
How did you hear of UPNS? Were you referred by a current or former UPNS family?
*
Application Fee:
Fee
*
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Application Fee
$
25.00
Total
$
0.00
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