The Long Island Institute of Professional Studies

Registration Form

Po Box 1011, Miller Place, N.Y. 11764   516-524-8981/631-473-8500/

TUITION:    $1,500 for Brooklyn College Courses ($100 non-refundable deposit required with registration)  OR $90.00 per in-service credit ($270.00 for a 3 credit course).   Make checks payable to:  Long Island Institute of Professional Studies or LIIPS.      

Please complete ALL sections of the registration form and mail to the address above. You can also call or text your registration in to 516-524-8981.  A minimum deposit of $50.00 (refundable or transferable) per course must accompany all registrations.  New students are automatically entitled to a $20.00 discount off their first course with us.  No discounts apply to Brooklyn College Graduate courses or cc payments.  BC tuition must be paid @ or before the first class.  Please call the office if other arrangements are needed.

Did you pre-register over the phone?    yes      or        no       Have you taken a course with us before?    yes     or     no    

How did you hear about LIIPS?_________________________________________________________

SESSION:               FALL            SPRING            SUMMER            (please circle)

Name___________________________________________________________    E-mail Address__________________________

Street Address___________________________________________________________________________________________

Town ______________________________         Zip Code___________________    DOB/LAST 4 SS#    _______________________      

School District_____________________________________   Cell  Phone(_______)___________________________

Course Title & Number (if applicable)                                                    Site           Circle: Graduate or in-service      Start Date

_______________________________________________________           _______            G or IS                                  ________

________________________________________________________________                ________               G or IS                                ________

________________________________________________________________                 ________              G or IS                                 ________ 

Site = Online, Smithtown (ST),  Nassau (NS),  or Riverhead (RV)              NOTE - PAYPAL is available on our home page.

CREDIT CARD  Payment:  MC,  VISA,  DIS or AMEX (please circle).  Remember if you are a new student you are entitled to a $20.00 "new" student welcome discount!  Note:  No discounts on Brooklyn College Graduate courses or cc payments.

credit card #   ____________________________________________________________         exp._______________

Total to be charged to your credit card: $  __________      Signature:      ________________________________________       (required if using a credit card)

Please note:  Graduate classes will be limited to 30 students.  Full payment must be received by the last class of the course in order to receive credit.  In-person payment can be accepted at the class site. Please assume your registration is accepted unless otherwise notified.