NAME ____________________________________________________________

STUDENT NUMBER (not Social Security) __________________________________________

LOCAL ADDRESS _________________________________________________________

CITY ________________________________ STATE __________ ZIP _________________

EMAIL ______________________________________

TELEPHONE ________________________________

Area of Interest - Select one area for your audition and fill in the information required:

____ DESIGN/PRODUCTION - Rank experience/interest from 1 - 5 (one being the highest):

Costumes ___ Lighting ___ Properties ___ Publicity ___ Scenery ___ Stage Management ___

____ PERFORMANCE - Audition Piece (List Play/Song & Character)

1.

2.

Current Cumulative Grade Point Average (minimum 3.00/minimum 3.30 HS GPA): _______

Class Standing: _____ Freshman _____ Sophomore _____ Junior _____ Senior

New Transfer Student (3.0 GPA required) _____

To the best of my knowledge the information provided on this application is true and accurate.

I understand that this CAPA Scholarship may cover only the current academic year.

Signature ________________________________________________ Date _____________

Please write a brief statement concerning your reason for majoring in theatre. What do you plan to do in the year after graduation? What are your long-range goals? If there are special circumstances you wish to bring to the attention of the selection committee, please feel free to do so. Please limit your statement to no more than one double-spaced typewritten page.

RESUME OF THEATRICAL EXPERIENCE:

All applicants, please list your Design/Production and Performance experience in the Department (or professional theatre if applicable). Incoming students list your experience at your previous school.

DESIGN/PRODUCTION (Costumes, Lighting, Properties, Publicity, Scenery, Stage Management):

SHOW	POSITION	THEATRE

PERFORMANCE

SHOW

ROLE

THEATRE