EFTA00090256 # Application for Admission ## About This Form MAR 01 1986 Please answer all questions below. Refer to the "Admissions" section of the Camp Extra (page 2) for complete application and financial aid information. The application deadline for first priority review is February 15. Applications may offer this date are welcome and will be received on a rollout admission basis. Send all materials to: Admissions Office Sorry, but we cannot process an incomplete application. ## Application Checklist - Completed Application and Course Selection Form - Application Form Signatures - $225. Application For Admission Materials Included if Required (see your division) / Course Description in the Camp Extra) ## Camp Application Fee Please enclose the required $225 with your application. Make checks payable to If you wish, you may charge the application fee to VISA, MasterCard, Discover or American Express. ## Signature(s) We cannot grant your application without the signatures of Applicant and Parent/Guardian. ## Applicant Information What Division are you applying for? □ Junior Session A □ Junior Session B □ Intermediate Session A □ Intermediate Session B High School □ Advanced Spring Quarter Institute (Session A-High School only) □ Creative Writing Institute (Session B-High School only) Date of this Application State 9 Zip Area Code + Number Grade completed by June Social Security Number No. How have you previously attended Interclub Arts Camp (including All-Sum)? Write years attended: 2 (1994,1995) Friend How did you first learn about Interclub? Optional: Applicant please indicate: Asian American African American Mexican American Puerto Rican Asian Native American Caucasian Other, please specify: ## Citizenship Information If you are not a U.S. Citizen, please complete this section. Country of Birth Country using the passport you will use to travel Home Street Address City State Zip Home Telephone: Area Code + Number Fax Number: Area Code + Number ## Teacher Information Name of current principal in your area. Home Street Address City State Zip Home Telephone: Area Code + Number Fax Number: Area Code + Number Office Telephone: Area Code + Number ## For Internal Use # 111494336 Sch/A Audition # T 745 I-20 N MAJ T MUCCL Accept EFTA00090257 Parent or Guardian Information Home State Address City Name Zip Name of Employee and address Office Telephone: Area Code • Number Office Fax: Area Code • Number Financial Information If you are applying for aid, please fill out this section. Are you applying for financial aid? Yes No Are you applying for The Governor’s Scholar Program? Yes No Does the student applying expect to be the recipient of any funds (scholarship, grant, award or prize) from any country, state, organization or individual specifically for attendance at the Interscholastic Arts Camp? Yes No Mother or Guardian Please Answer If yes, name the title of award, source of award and amount. What is it? Earnings this year. Value of real estate. Earnings this year. Value of real estate. Please attach a copy of your most recent Federal Tax Form 1040 to this form. Choosing a Major All Juniors (grades 3-6) are designated as General Arts below. Intermediate Division (grades 6-9) and High School only minor courses, your designated major will be General Programs in the Intermediate and High School Divisions. The information below must be completed in. Junior Please refer to the "Junior Division" section in the Campus requisites and audition requirements. 1. Session A: Band or String Orchestra Instrument 2. Session B: Band or String Orchestra Instrument Intermediate Please enter the Major Code from the Camp Extra (i.e. DMUCN or BCLAR-INET) Please refer to the "Intermediate Division" section in the Camp Extra for a complete discussion of major arts activities, course codes, class scheduling, prerequisites and audition requirements. 1. Session A: (first choice major code/instrument) 2. Session B: (first choice major code/instrument) 2. Session A: (second choice major code/instrument) 2. Session B: (second choice major code/instrument) High School Please enter the Major and Code from the Camp Extra (i.e. TMUCL OR OVIOLIN) Please refer to the "High School Division" section in the Camp Extra for a complete discussion of major arts activities, daily class scheduling, prerequisites and audition requirements. 1. First Choice Major Course Name and Code Instrument (if applicable) 2. Concert Choir Major Course Name and Code Instrument (if applicable) 3. Third Choice Major Course Name and Code Instrument (if applicable) INT000049