+Actor Application Form

First name

Last name

Preferred pronouns

Email

Phone

Birthday

Day

Month

Year

Current Year Level

Parent/Guardian name

Parent/Guardian phone

Parent/Guardian email

Which program are you interested in?

What are your expectations/goals that you hope to acheive in this program?

What are your specific areas of interest or strengths you would like to focus on?

Have you participated in any actors programs or skill development programs before? If so, please provide details.

Do you have any specific challenges or areas where you would like additional support?

Do you have any concerns with dates/times

Yes

No

Would you be interested in ongoing mentoring and coaching?

Yes

No

Do you grant permission for The Positive Mentor who is hosting this short course, to use any images used for promotions and marketing?

Yes

No

Upload a recent headshot of yourself (with parental/guardian approval for those under 18 years)

Signature (Parent/Guardian must sign for applicants under the age of 18)

Print Name of signed

Is there any additional information or special accommodations that you would like us to be aware of?