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Summer
Teen Workshop
June 18 - 22, 2006
Please
Print Out and Complete This Application in its Entirety:
Your Name
______________________________________________
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Male |
Female |
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Grad Year: |
2005 |
2006 |
Address ________________________________________________
City ________________ State ________________ Zip __________
Home Phone (____) _______________________________________
Email ___________________________________________________
High School______________________________________________
Age (if under 18) _______________________________________
School Telephone (____)__________________________________
Please check the workshop you want to attend (choose
one only):
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Advertising |
Digital Media Production |
Interior Design |
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Apparel Accessory Design |
Game Art & Design |
Media Arts & Animation |
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Apparel Design |
Graphic Design |
Visual Effects & Motion Graphics |
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Design Management |
Interactive Media Design |
Visual & Game Programming |
In
case your first choice is unavailable, please write in an alternate choice:
_____________________________________
This
application will not be processed without a parent or guardian signature:
Your Signature _____________________________________ Date __________
Parent / Guardian Signature __________________________________ Date __________
Application Checklist (all these items must accompany this appliction)
Ôø‡Ôø‡
$25 Registration Fee
(by money order or check payable to The Art Institute of Portland
or by credit card - fill out information below).
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VISA |
MasterCard |
American Express |
Ôø‡Ôø‡
Credit Card Number
___________________________
Ôø‡Ôø‡
Expiration Date
______________________________
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Name on Card
Ôø‡Ôø‡
Essay
Ôø‡Ôø‡
Letter of
recommendation from your instructor or guidance counselor.
Please send information to my friend who may also be
interested:
My Friend's Name ________________________________________
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Male |
Female |
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Grad Year: |
2005 |
2006 |
Address ________________________________________________
City ________________State ________________Zip __________
Home Phone (____) _______________________________________
Email ___________________________________________________
High School______________________________________________
School Telephone (____)__________________________________
Mail
completed Application and all materials to:
Summer Teen Workshop Coordinator
The Art Institute of Portland
1122 NW Davis Street
Portland, OR 97209-2911