Join Our Team — Buffalo State Lyceum Project

Buffalo State Lyceum Project

By filling out this brief application, you agree to participate in a week long academic summer camp via Zoom. You agree to attend everyday from 2:00 pm-4:00 pm as well as participate in all activities associated with the program. If you would like to opt out of having any pictures of you for media purposes, please select the OPT OUT option.

Student's Full Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #

Grade Completed as of June 2021

Student Email Address

Why Do You Want to Participate in the Lyceum?

Briefly explain why you would like to join our crew this summer!

Parent/Guardian Full Name

First Name

Last Name

Parent/Guardian Phone Number

Parent/Guardian Email Address

Opt Out of Photos?

Select YES if you do not want your pictures used. Select NO if you are willing to consent to having your pictures used.