Name:

Address:

City:

State:

Zip Code:

Phone:       E-mail Address:

Current School:

Current drama/speech coach(es):

Name and relationship of reference letter writer:

In case of emergency contact:

Phone:

Relationship:

Scholarship information (please specify area of emphasis).

I will be:
Performing monologues                          Title                          Author
Bringing a technical/design portfolio   1.               Both                                                    2.  

Intended major(s):

Intended minor(s):

Current GPA:    Class rank:   ACT score:

Have you applied to Simpson? yes or no  

Have you been accepted? yes or no

Previous activities in performing arts (please be specific)

 Honors and awards

Please check each area listed below in which you have skill or experience:

Do you play a musical instrument? yes or no If so, what?

Do you have a relevant skill in other than those listed above?

Would you be interested in a workstudy position in the theatre department?

What area(s) would you prefer to work [no previous experience necessary]

Explain your interest in theatre and describe the contribution you think you will make to Theatre Simpson next year.

I understand that in accepting an award I agree to support actively and regularly departmental programs that I am expected to be involved (in whatever way is most appropriate) in departmental production and that I am to maintain a GPA above 2.5 in departmental classes and a general GPA above 2.0

                   
Signature                                                         Date