Student Application / Registration 2009



Student Application / Registration 2011

Film 1o1 Workshop

June 9-12, 2011

Student Information Please print or type clearly. Name:___________________________

Level of participation: College-_____Teacher-_____ Other-____

Age: __________ Date of Birth ___________ Sex: M F

Address _________________________________________________________

City: _____________________ State: ______________ Zip _______________

Email Address___ ________________________________________________

Home Phone___________________ Cell Phone___________________________

(the following applies to College students only)

Father’s Name ________________________ Home Phone ________________

Work Phone __________________________ Cell Phone __________________

Mother’s Name ________________________ Home Phone ________________

Work Phone __________________________ Cell Phone __________________

Will you be parking a car on campus? Yes No

If so please give make, model and license plate #

Will you need housing? Yes No

Do you have a specific roommate request? YES NO

(Both students must request to room together)

Roommate Request Name __________________________________________

T-Shirt Size: (circle one) S M L XL XXL

Mail Application and $200 Deposit by May 15, 2011 to:

Department of Theatre & Dance

ATTN: Film 1o1 Workshop

Texas State University

601 University Drive

San Marcos, TX 78666

THE $200 DOLLAR DEPOSIT IS NONREFUNDABLE

NOTE: PAYMENT MUST BE CASH, CHECK OR MONEY ORDER. NO CREDIT CARDS!

For further information, email tc20@txstate.edu , or call (512) 245-2147

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