Theatre Scholarship Application

NAME _____________________________________ DATE _____________________

HOME ADDRESS _______________________________________________________

CITY __________________________ STATE _______ ZIP CODE _______________

SSN ___________________________ HOME PHONE __________________________

PARENT/GUARDIAN ___________________ HOME PHONE ___________________

LAST SCHOOL ATTENDED ______________________________________________

(Northeast, High School, or other college)

DATE OF BIRTH _______________ COLLEGE MAJOR _______________________

HAIR COLOR ______________ HEIGHT _________ EYE COLOR _______________

ACT SCORE ___ CURRENT GPA ____ YEARS EXPERIENCE (in drama) _________

PLEASE LIST YOUR BACKGROUND IN DRAMA PRODUCTION BELOW.

(Include any experience performance production or administrative.)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

LIST THREE PERSONAL REFERENCES:

Reference 1- Name ________________________________ Phone _________________

________________________________________________________________________

Occupation or Relation Address E-mail

Reference 2- Name ________________________________ Phone _________________

________________________________________________________________________

Occupation or Relation Address E-mail

Reference 3- Name ________________________________ Phone _________________

________________________________________________________________________

Occupation or Relation Address E-mail

Scholarship Awarded? (YES) ____ (NO) ____ Date Notified: _________