Marjorie Ingram Griffin Scholarship Application

Department of Theatre Arts
Eastern Illinois University

Date / MM / DD YYYY
I am a declared Theatre Arts major with Teacher Certification: Yes No
Second Teaching area?
Name First Last
E Number
Enter semester you plan to student teach
Home Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Email
Alternate Email
Male Female
Date of Birth / MM / DD YYYY
EDUCATION BACKGROUND

EIU GPA on a 4.0 scale
Date of GPA Record / MM / DD YYYY
College or High School attended, list last attended first
Location
Major
Degree or Diploma?
Years in attendance
College or High School attended, list last attended first
Years in attendance
Degree or Diploma?

Indicate if you received a degree or diploma. If none was received, list highest level of education.
Major
Location
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THEATRE EXPERIENCE - List the name and address of theatres you have worked, most recent first:

WORK EXPERIENCE #1:
WORK EXPERIENCE #2:
WORK EXPERIENCE #3:
WORK EXPERIENCE #4:
TECHNICAL EXPERIENCE - Set design, costuming, lighting, etc. List the title of the play, position or responsibility, and the name of the theatre, from Work Experience list, most recent first.

TECHNICAL EXPERIENCE #1:
TECHNICAL EXPERIENCE #2:
TECHNICAL EXPERIENCE #3:
TECHNICAL EXPERIENCE #4:
TECHNICAL EXPERIENCE #5:
TECHNICAL EXPERIENCE #6:
ACTING EXPERIENCE - List the title of the play or musical, name of character and name of the theatre, from Work Experience list, most recent first.

ACTING EXPERIENCE #1:
ACTING EXPERIENCE #2:
ACTING EXPERIENCE #3:
ACTING EXPERIENCE #4:
ACTING EXPERIENCE #5:
ACTING EXPERIENCE #6:
REFERENCES - List below the name, e-mail, and phone number of three people you have asked to send letters of reference on your behalf:
Reference #1 Name: * First Last
Email
Phone - (###) - ### ####
Reference #2 Name: * First Last
Email
Phone - (###) - ### ####
Reference #3 Name: * First Last
Email
Phone - (###) - ### ####
COMMENTS - You may use this space for any comments that you think might be helpful in evaluating this application, e.g. "special skills" or "talents."
Thank you for completing this application, once you hit SUBMIT the application will be e-mailed to the EIU Theatre Dept. No interview/audition is required to be awarded this scholarship.
Revised for web 10/18/2011

Marjorie Ingram Griffin Scholarship Application

Marjorie Ingram Griffin Scholarship Application

REFERENCES - List below the name, e-mail, and phone number of three people you have asked to send letters of reference on your behalf:

Thank you for completing this application, once you hit SUBMIT the application will be e-mailed to the EIU Theatre Dept. No interview/audition is required to be awarded this scholarship.

Revised for web 10/18/2011