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: _________