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.

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

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* 2. What is your first and last name?

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* 3. What is your relationship to the student?

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

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

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* 6. How old is the student?

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* 7. What is the student's birthday?

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* 8. What is your preferred mode of communication?

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

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

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

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* 12. Does the student have a disability?

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* 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.

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

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