Administration: PO Box 86 Harrisonburg, Virginia 22803 USA Tel: (540) 867-5571
The Caux Artists Program, July 7- 20, 2013, Caux, Switzerland
Please check all that apply:
__Singer __ Actor __ Dancer __Composer __ Instrumentalist(Instrument) ______
Confidential. Please print or type all information.
Name:
FAMILY NAME FIRST NAME Male or Female:
How did you learn about the Caux Artists Program?
If you are accepted, we will communicate with you primarily via email. PLEASE provide current, reliable, contact information andbe sure to check your email regularly.
.
Current Address:
STREET AND NUMBER CITY / STATE / COUNTRY ZIP CODE TELEPHONE
This Address Is Valid Until:
Permanent Address:
STREET AND NUMBER CITY / STATE / COUNTRY ZIP CODE TELEPHONE
Parent(s) or Guardian:
Address:
STREET AND NUMBER CITY / STATE / COUNTRY ZIP CODE TELEPHONE
Date and Country of Birth: Nationality
(day/month/year)
Passport No: Date of Expiration:
(day/month/year)
PAGE 2EXPERIENCES
5
Please describe foreign travel or study experience, including countries, reason for travel or study and dates:
Previous Internships / Honors / Competitions:
DATES / LOCATION
DATES / LOCATION
Please supply two (2) written references, including at least one academic reference.
These written references may be sent directly with your application (email or letter).
Names of those giving references:
NAMETITLETELEPHONE/EMAIL
NAMETITLE TELEPHONE/EMAIL
FINANCES
How do you plan to pay for the program? Circle and describe:
1. Self 2. Parents:3. University Financial Aid 4. Other funding/grant
Note: Please provide the information below.
Undergraduate College/University:
Address:
STREET AND NUMBER CITY / STATE / COUNTRYZIP CODE
Year at University (Circle One): 1 2 3 4 Graduated Date of Enrollment: Graduation date:
month/year month/year
Major Degree:2nd Major/Minor:
Extra Curricular Activities:
Graduate School:
Circle One: MA, MFA, PhD, Other
Subject: Date of Enrollment:Graduation:
month/year month/year
Please describe your talents, skills, hobbies and/or special interests:
List any foreign languages you speak, read and/or write, and indicate level of fluency:
Language: Speaking skills Reading skills Writing skills
English
Please describe your community activities:
In 200 words or less, please describe why you would like to participate in the CAUX ARTISTS PROGRAM. You may wish to share what vision you have for your art in your community and /or society. Your response is very important, as it will help distinguish you from other candidates for our limited number of places.
My DEMO - CD of at least two songs of different styles is enclosed / will be emailed as MP3s (circle one).
ACTORS / DANCERS: you will be contacted by our faculty for a SKYPE audition/interview.
I certify that the information in this application is accurate.
Signature: Date
Return this application form to:
CAUX ARTISTS PROGRAM PO Box 86 Harrisonburg, Virginia 22803 USA
This form can be returned via e-mail:
Any questions, e-mail or call: ++(540) 867-5571