Name

Age

Date of Birth

Address 1

Address 2

City

State

Zip

Home Phone

Cell

Email

Name of Parent(s) or Guardians(s)

High School

Class Rank

Class Size

GPA (2.5 min)

ACT (21 min)

Graduation Year

Drama Coach

Primary Interest

Select One: Design Musical Theatre Performance Technical Theatre

Intended Major

Intended Minor

Awards/Honors

Theatre Experience

What are your goals in majoring in Theatre Arts and how will a scholarship assist you in attaining these goals?

Goal #1

Goal #2

Please list two references who are familiar with your work in theatre.

Reference #1
(Name, email, position, phone)

Reference #2
(Name, email, position, phone)