Screen Reader Mode Icon

Student + Parent / Caregiver Information

Please complete this form in order to add a student to the Live Art interview list. Please complete one form per student interested in Live Art. We conduct interviews for Live Art in the summer before the new program year; you will be contacted by programmatic leadership about an interview at that time.

Question Title

* 1. What is the student's first and last name?

Question Title

* 2. What is your first and last name?

Question Title

* 3. What is your relationship to the student?

Question Title

* 4. What is the best email address to reach you?

Question Title

* 5. What is the best phone number to reach you?

Question Title

* 6. How old is the student?

Question Title

* 7. What is the student's birthday?

Question Title

* 8. What is your preferred mode of communication?

Question Title

* 9. Please describe why the student is interested in Live Art.

Question Title

* 10. Please share the student's performing arts areas of interest. Check all that apply.

Question Title

* 11. Please describe what the student needs to be successful and/or what access needs the student has.

Question Title

* 12. Does the student have a disability?

Question Title

* 13. If you answered "yes" to the question above, please share any information that is helpful to programmatic staff. If you answered "no," please write N/A.

Question Title

* 14. If you have any additional information or thoughts to share, please do so here.

0 of 14 answered
 

T