Admissions Application Request - Main Form

Welcome!
Contact Information
Personal Information
Emergency Contacts
Additional Information
Additional Information

is required

is Required

First Name
Middle Name
Last Name
Nickname/Stage Name
Email Address
Date of Birth
Gender
Preferred Pronouns
Citizenship Status
Citizenship Country
By checking this box, you consent to receive text messages and marketing emails from The Lee Strasberg Theatre & Film Institute.

is Required

Home Address & Phone Number
Country
Street Address 1
Street Address 2
City
State
Zip Code Zip Code Extension
Province
Postal Code
Mobile Phone Mobile Phone Area Code Mobile Phone Exchange Mobile Phone Number Mobile Phone Extension Ext:
International Mobile Phone International Mobile Phone Extension Ext:
Mailing Address
Copy Home Address Into Mail Address
Country
Mailing Address 1
Mailing Address 2
Mailing City
Mailing State
Mailing Zip Code Mailing Zip Code Extension
Mailing Province
Mailing Postal Code

is Required

Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Email
Emergency Contact US # Emergency Contact US # Area Code Emergency Contact US # Exchange Emergency US Phone Number Emergency Contact US # Extension Ext:

is Required

Choose Program of Study
Choose New Start Term

is Required

I certify that to the best of my knowledge the foregoing information I have provided on this application is accurate and correct.

Yes
Date (mm/dd/yyyy)
Digital Signature (Please type your full name)
First Language Spoken
If other preference, please list:
SAG-AFTRA Member?

Previous
Next

Previous
Next