Cooperative Artist Institute

PEACE DRUM TEEN APPLICATION

Once we receive your application, we'll contact you to schedule an interview with the Peace Drum Staff. Apply soon because the project begins in October.

Name:
Address:
City/St/Zip:
Phone:
Age:
School/Grade:
Parent or Guardian:

Which area of the arts are you most interested in?

Music	Acting	Visual Arts
Dance	Film/Video
Have you had any prior experience or classes in this area?
Please list other extra curricular activities you are involved in this year:
Are you employed? If so, where?
Have you ever been involved in community service projects before? Briefly describe:
Do you personally know any elderly people in your community (a grandparent or neighbor)?
Are you available on Tuesdays after school from 3:00-5:30 PM from October 9 through May, 2005?			Yes
			No
How did you hear about The Peace Drum Project?
Please provide the name and phone number of a school or community center reference:

If you have questions please call Susan Porter at 617-254-6378