PAVAN - Performing and Visual Arts Northwest - Summer Regional Governor's School Application

Please enter the following information.

Applicants First Name:

Last Name:

Middle Initial:

Gender:

Male

Female

Street Address/Box Number:

Town/City:

State:

Zip Code:

Age:

Date of Birth:

DD/MM/YYYY

Parent/Guardian’s First and Last Name:

Home Phone Number (with area code):

Work Number(s) Including Extension:

Parent’s Cell Phone:

E-mail Address:

Secondary Emergency Contact First and Last Name:

Work Phone:

Cell Phone:

Applicant's E-mail Address

Applicant’s E-mail Address (required) You will receive confirmation of PAVAN receiving your application via e-mail only.

I wish to apply and audition in the following area:

	Visual Arts	Theater
	Guitar	Dance
	Vocal Music	Instrumental Jazz

My Residence is in:

Current Grade (Seniors can not apply.)

School Student Currently Attends:

School Will Attend Fall 2010:

My school is:

	Public
	Private
	Home-Schooled

*All applicants must be prepared for an audition/portfolio review as well as an interview component. Audition and portfolio requirements will be mailed to you once your application is received and your application reviewed for completeness and the PAVAN office has received your teacher’s letter of recommendation. If there are any questions about your application, PAVAN will be in contact with you immediately.

Parent/Guardian Statement

My child, , has my permission to participate in the 2010 Summer Regional Governor’s School. Both my child and I are aware that in order to be eligible my child MUST attend an audition (to be assigned upon receipt of this paperwork). If my child does not attend their audition, I understand my child cannot attend the Governor’s School. I also understand my child’s attendance at all class sessions is both expected and required because he/she is receiving a scholarship. In addition, I will ensure my child’s application is complete and that if accepted, all paperwork is completed and received by the PAVAN office before my child may attend the program.

If my child is accepted, I understand my child and I will receive a handbook, medical forms and conduct agreements which we will both be required to read, sign and return to the PAVAN office. Acceptance notification letters will be mailed in mid- to late-April.

Click if you accept this agreement.

I accept these terms

PAVAN asks that you give sufficient notice in advance if you will not be able to attend your assigned audition. There is always a waiting list and this way another applicant may take your place. Thank you!

*Please note: The teacher recommendation may be sent with the student’s application only if it is in a separate, sealed envelope so it remains confidential. The teacher recommendation may also be sent separately if the teacher wishes. However, the student’s application is not complete and will not be considered until the teacher recommendation form has been received.

Thank you.

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