2023 Summer Ambassador Program Student Form

2023 Summer Ambassador Program

Student Application
When: July 17 to July 21, 2023 8:30 a.m. - 12:30 p.m.

Where: Hauppauge High School, 500 Lincoln Blvd, Hauppauge, NY 11788

Application Deadline: May 15, 2023.

All applicants must submit a teacher recommendation.
Applications and recommendations may be submitted separately. Please ask your teacher to complete a teacher reccomendation form which will be sent to them after you apply.

Transportation:

All students

Fee: $100*

*Scholarships available. To apply for a scholarship, email ambassador@stagethechange.org
Student Application

Deadline: May 15, 2023
Last Name of Student:*
First Name of Student:*
Date of Birth*

MonthDayYear
Date
Age:*
Current Grade:*
Best way to contact you?*

EmailCell phone
Student Email:*
Student Cell Phone Number:*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of School:*
Last Name of arts teacher recommending you:*
First Name of arts teacher recommending you:*
Teacher's email address:*
Last Name of parent/guardian:*
First Name of parent/guardian:*
Parent/Guardian Cell Phone:*
Home Phone (optional):
Parent/Guardian Email Address:*
I have attended the Stage the Change conference (not mandatory to attend the Ambassador program)*

YesNo
Why are you interested in participating in the Stage the Change Ambassador Program? (250 words or less)*

0/250
How do you see yourself impacting the world through your art (100 words or less)*

0/100
Please list your prior theatre, writing, or performance experience (200 words or less)*

0/200
Are you involved in any other activism in school or out? (100 words or less)*

0/100
Tell us about your favorite recent theatre experience and why it was important to you. (100 words or less)*

0/100
Should be Empty:

2023 Summer Ambassador Program

Student Application