SECTION 1 GENERAL INFO

NAME:  LAST   FIRST   MIDDLE

RACIAL IDENTITY  

African-American (Black) 

Alaska Native

Asian 

Caucasian (White) 

Hispanic (Latino)  

Native American (American Indian) 

Native Hawaiian and Other Pacific Islander

Multi-Racial Indicate Races  

VALID ID

Is the information on your ID the same as the CURRENT information provided here?    Yes    No

If "NO"  please explain why.  Married  Divorced Widowed Recently Moved 

Other, (please explain)

LEAD ROLE INTEREST

CAN PERFORM LEAD ROLES AS:  Actor Model Singer Dancer  Rapper 

OTHER ARTISTIC TALENTS:   

EDUCATION

SCHOOL OR COLLEGE NAME:MAJOR/MINOR:

DEGREE OBTAINED  GRADUATION DATE:

SECTION 2  PARENT OR GUARDIAN INFO (If 18 or older skip this section.)

PRINT PARENT or GUARDIAN'S NAME: 

PARENT or GUARDIAN'S ADDRESS (if different):

CITY, STATE ZIP (if different):

PARENT or GUARDIAN'S SIGNATURE:DATE APPROVED://

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