Name_________________________________________________________________
Last First M.I.
S.S. #____________________________ D.O.B.______________________
Address__________________________ Phone # _____________________
_________________________________ Email_______________________
High School____________________________________________________________
Address___________________________ Graduation date_______________
__________________________________
Intended College_________________________________________________________
College Address_____________________ Major _______________________
__________________________________
Film or video experience/credits______________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Use
back if necessary)
Also required :
1) a 300-500 word essay describing what the student hopes to accomplish through the art of film or video in school or their career.
2) a 3 to 12 minute VHS video of the student’s work
3) 2 reference letters from individuals other than members of family.
______________________________ _____________________________
Applicant
Signature Date Parent Signature Date