2007 VCUarts Summer Intensive!

Residency Program for High School Students: Fine Arts, Design Arts and
Performing Arts
July 8 -27th, 2007
Application for Admission

Student Information: Today’s Date: _____________________

First Name Middle Name Last Name Nickname

E-mail Address Home Phone Number Cell Phone Number

Permanent Address (Street, City, State, Zip, Country)

Date of Birth (mm/dd/yyyy)

*The VCUarts Summer Intensive is intended to be a residential learning and living

experience. To gain maximum benefit from this program we recommend that all
participants reside in the residence halls.
Student Preference: ____ On-campus housing ___ Daily Commuter
Gender: ____ Male ____ Female

Parent/Guardian Information:

Name(s) Relationship to Student

Day Phone Cell Phone Evening Phone

Fax Email

Mailing Address City State Zip

Indicate your area of interest (select only one):

____ Animation ____ 2D and 3D Fine Arts Portfolio Building
____ Digital Filmmaking ____ Writing for the Arts
____ Digital Photography ____ Theatre
____ Fashion Design and Merchandising ____ Dance
 2007 VCUarts Summer Intensive! Application for Admission (continued)

How did you hear about the Summer Intensive?

Newspaper Ad ____ Web Site _____ Former Participant ____ Teacher ____
VCU Open House ____ Postcard ____ Other, please explain: _____________________________

High School Information: Anticipated graduation date: ________________

High School Name

School Mailing Address City State Zip Country

Name of current art or performance teacher:

Ms. / Mr. / Dr. (please circle one)

All applicants must submit the following materials along with their application:
• Teacher Recommendation Form – to be completed by an instructor in your primary
interest area or if you have never participated in a course such as the one you are
signing up for select any teacher who can speak to your creativity.
• Computer and Internet Acceptable Use Policy agreement signed by the student and a
parent or guardian.
• Medical Release Form completed and signed by parent or guardian.

Fine Arts and Design Arts applicants must submit a description (250 words or less) of their
experience in their primary area of interest and why they want to attend the Intensive.
Fashion Design and Merchandising applicants please also include any training in sewing and
creating clothing, as well as designers/artists who have had a major influence on you.
All Fine Arts and Design Arts applicants please include which artists’ work has had a major impact
on you. (This includes all programs except dance and theatre.)

Dance applicants must submit a one-page resume listing dance training and experience.
Theatre applicants must submit a one-page resume highlighting (1) theatrical training and
experience, (2) vocal range and singing experience, (3) dance experience (if any), and a letter stating
what their goals are for taking the Intensive.

Tuition and Fees:

All participants pay a $50 materials and supply fee.
Tuition:
Residential participants: $2400 (includes a room and all meals)
Commuting participants: $2025 (includes lunch and dinner meals)
*Fees do not include field trips on both weekends. Accepted students will receive information regarding selecting their field trip
preferences.

Parking: Students who bring a vehicle will be required to pay for parking in advance. Cost for parking
will be $5 per day. Do you anticipate bringing a car if you are accepted into the program? ____yes
____no
Application Fee:
There is a $50 non-refundable application fee. You may make payments by check or credit card.
Please make checks payable to Virginia Commonwealth University - School of the Arts.
Select payment method:
____ Check Enclosed ____ Credit Card

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 2007 VCUarts Summer Intensive! Application for Admission (continued)

Credit Card Information: (please circle one) Visa / MasterCard

$50.00
Card Number Expiration Date Application Fee
Name as it appears on credit card ___________________________________________________
Credit Card billing address if different from address above:

Street Address City State Zip

Signature of Cardholder ___________________________________________________________

Does the student have any learning challenges his or her professor needs to be made
aware of? ___ Yes ___ No If so, please explain:

Refund Policy: Tuition refunds (minus the non-refundable $50 application fee and $300 deposit)
will be made to those who cancel their enrollment prior to July 1, 2007. No refunds will be available
after that time. (This includes students who decide to leave VCU due to homesickness.)
Certification: We (Student and Parent/Guardian) have reviewed the VCUarts Summer Intensive
Refund Policy included in this document, and agree to abide by all established policies and deadlines.
Additionally, we understand and agree that VCUarts has permission to use images of participants and
their artwork or performances in future publications, presentations and websites.

As parent/guardian, I give ________________________ (student’s name) permission to participate in

the program and attend any staff-supervised field trips. I release VCU for any liability associated with
field trips.

Parent/Guardian signature

If accepted into the program, I agree to diligently and enthusiastically participate in the program and to
treat peers and staff with respect. I agree not to behave disruptively or in a manner that would limit
other students’ enjoyment or learning. I understand that I may be required to leave the program if I do
not adhere to the established rules and regulations.

Student signature
Deadlines and Important Dates:
• May 14, 2007: Completed application with all supporting materials and $50 non-refundable
application fee is due to VCUarts Summer Intensive!
• All applicants will be notified of their acceptance or wait-list status prior to May 21, 2007.
• June 1, 2007: Participant’s $300 non-refundable deposit is due to reserve space in the program.
• June 21, 2007: Balance of tuition, supply and parking fees are due for all participants;
enrollment is not guaranteed to any applicant whose tuition and fees are unpaid after this date.
Send Applications to:
Mail the completed VCU Summer Arts application (including all required supplemental materials) and
check or credit card information to:
VCUarts Summer Arts Intensive! Questions? Contact:
609 Bowe Street, Room 513c Dr. Mitzi Gregory, Program Director
P.O. Box 843047 Phone: 1-866-534-3201 (toll-free)
Richmond, VA 23284-3047 e-mail: [email protected]
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 2007 VCUarts Summer Intensive!
MEDICAL INFORMATION/RELEASE FORM

Participant Name Today’s Date

Is the participant currently taking any medication: Yes ____ No ____

(Please consider both prescription drugs and over-the-counter medication.)

If the answer is yes, please list each medication on the next page of this form and provide all
requested information. Include prescription drugs and over-the-counter medication that
might be needed for headaches, cramps, insect bites, hay fever, etc.

Does the participant have allergies to food, medication, insect bites, plants, or anything else about
which we should be informed? Yes ____ No ____
If the answer is yes, please describe below: (Does the student have an inhaler or epi pen?)

Does the participant have any medical/emotional problems (i.e., asthma, eating disorders, anxiety
disorders, mononucleosis, anemia, heart disease, diabetes, depression, etc.) of which we should be
aware? Yes ____ No ____
If the answer is yes, please describe below:

Emergency Contact 1 Home Phone Cell Phone Work Phone

Emergency Contact 2 Home Phone Cell Phone Work Phone

Insurance Policy Information: Attach a copy of front/back of the insurance

card in case medical attention is necessary.

Policy Holder’s Name Relationship to participant

Policy Holder’s Address if different from above

Insurance Company Policy Number

Insurance Company Address Insurance Company Phone

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 2007 VCUarts Summer Intensive!
MEDICAL INFORMATION/RELEASE FORM (continued)

Participant Name

Please provide the following information concerning all medications that the student is currently taking.
Include prescription drugs and over-the-counter medicines that might be needed for headaches,
cramps, insect bites, hay fever, etc.

Please send the medication with the student; it will be kept by him or her unless we are notified
otherwise.

Name of Medication 1 Why taken

Dosage Frequency of Dosage

Name of Medication 2 Why taken

Dosage Frequency of Dosage

Name of Medication 3 Why taken

Dosage Frequency of Dosage

Name of Medication 4 Why taken

Dosage Frequency of Dosage

Name of Medication 5 Why taken

Dosage Frequency of Dosage

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 2007 VCUarts Summer Intensive!
MEDICAL INFORMATION/RELEASE FORM (continued)

I give permission for, __________________________________ (Participant’s Name), to receive

medical and emergency care while at Virginia Commonwealth University Summer Arts Program and for
a physician or other appropriate medical personnel to treat my child in a manner he/she thinks
appropriate, in case of a medical emergency and/or a problem. I authorize the nurse on duty or the
chaperon (adult) to administer properly labeled over-the-counter medications that I may designate in
writing. Further, I permit my son/daughter to self-administer prescribed medications listed on previous
pages of this medical information form. I agree that all medications shall be in original containers, and
I waive the right to seek damages against the nurse or the chaperon administering such medication. I
understand that I am responsible for the payment of all medical and emergency services rendered to
my child.

Please list all medications, including over-the-counter medications that the Participant is allergic to:

Please attach:
• A Xeroxed copy of the front and back of your insurance card for
the health policy (policies) that cover(s) your child. Many
health care providers require that the card be presented before
care will be provided.
• Immunization records, please indicate approximate date of last tetanus
shot.

The above information is complete and accurate to the best of my knowledge.

Parent/Guardian signature

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 2007 VCUarts Summer Intensive!
Teacher Recommendation Form

Applicant fills out this portion

Name of Applicant: _____________________________________________________

Area of Interest indicated on Application ____________________________________

Teachers: Please complete remainder of form. Please note that the applicant will not be considered
without this form being completed. In a sealed envelope, please return completed form to the
applicant for inclusion in his/her application packet.

1. What course(s) has the student taken from you?

2. Please use the following rating scale to answer the questions below:

1 = Outstanding 2 = Above Average 3 = Average 4 = Needs Improvement NA= Not Applicable

Needs
Outstanding Improvement
a. Imagination/Originality: Develops new concepts and ideas 1 2 3 4 NA
b. Commitment: Demonstrates substantial interest in art form 1 2 3 4 NA
c. Technique/Ability/Skill:
Demonstrates expertise/high degree of skill in art form 1 2 3 4 NA
d. Willingness to collaborate:
Accepts ideas of others and contributes to group process 1 2 3 4 NA
e. Emotional stability, maturity, and self-discipline 1 2 3 4 NA
f. Openness to new experiences 1 2 3 4 NA
g. Ability to concentrate 1 2 3 4 NA
h. Ability to listen 1 2 3 4 NA
i. Ability to take risks 1 2 3 4 NA
j. Ability to be on time/promptness 1 2 3 4 NA
k. Ability to maintain a high energy level 1 2 3 4 NA

Fill out the following for Theatre applicants only:

a. Ability to trust self and use self 1 2 3 4 NA

b. Ability to dance 1 2 3 4 NA
c. Ability to sing 1 2 3 4 NA
d. Has student sung in a musical? ___ yes ___ no ___NA
e. If yes, did the student sing in: __ the chorus __ featured singer __NA
f. Student’s vocal range _______________________ or _____ NA

Questionnaire continued on next page

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 2007 VCUarts Summer Intensive!
Teacher Recommendation Form

Applicant fills out this portion

Name of Applicant: _____________________________________________________

Area of Interest indicated on Application ____________________________________

Fill out the following for Dance applicants only:

Technique Level:

Ballet: ____ Beginning ____ Intermediate ____ Advanced

Modern: ____ Beginning ____ Intermediate ____ Advanced

Does the applicant have alignment, physical or other problems of which we should be aware?
____ Yes _____ No
If yes, please briefly explain:

All Recommendations: Please comment on student talent, motivation and other qualities that make
him or her uniquely qualified for the VCUarts Summer Intensive:

Teacher Signature Printed Name

E-mail address Phone Number

Name of School Mailing address

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 2007 VCUarts Summer Intensive!
COMPUTER & INTERNET ACCEPTABLE USE POLICY

Purpose
To review procedures for the appropriate use of computers at VCUarts Summer Intensive!

General Principles
VCUarts Summer Intensive provides computer equipment and services for academic and artistic
purposes only. Academic and artistic purposes include those purposes directly related to an
assignment. Access to the Internet is provided to improve learning and teaching through research,
collaboration, and use of materials and resources. Access to computers carries responsibility for the
proper use of the computing facilities. VCUarts Summer Intensive recognizes that most students are
responsible and thoughtful users. The actions of a few irresponsible users, however, can disrupt and
interfere with the right of all users.

Procedures
Computer users must abide by the rules set forth. Inappropriate use may result in termination of
computer privileges, disciplinary action, and/or other actions determined appropriate, including legal
action.

The following are examples of computer and network use infractions that are prohibited for students:

1. Using the computer for purposes other than academic purposes.

2. System tampering (any unauthorized alteration of operating systems, individuals’ accounts,
software, and/or other programs).
3. Obtaining or using obscene, vulgar, abusive, or inappropriate language, pictures, or other material.
4. Knowingly introducing viruses.
5. Vandalizing, including equipment damage and willful tampering of data or software.
6. Attempting to decrypt passwords.
7. Attempting to gain unauthorized higher level of network privilege and access.
8. Attempting to gain unauthorized access to remote systems.
9. Deliberately interfering with other users.
10. Attempting to libel, slander, or harass other users.
11. Unauthorized copying or transferring of copyrighted materials, including, but not limited to music,
movies or videos, or any other violation of Copyright laws.
12. Placing copyrighted material on the network without permission of the author.
13. Plagiarizing, which is the taking of someone’s words, ideas, or findings and intentionally presenting
them as your own without properly giving credit to the source.
14. Using the computer for illegal activities.
15. Using commercial advertising, chain letters.
16. Using e-mail or Usenet news groups without the director’s or a teacher’s permission.

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 2007 VCUarts Summer Intensive!
COMPUTER & INTERNET

STUDENT USER AGREEMENT AND PARENT PERMISSION FORM

As a user of computers and Internet Services provided by the VCUarts Summer Intensive and Virginia
Commonwealth University, I agree to comply with the stated Computer & Internet Acceptable Use
Policy of the VCUarts Summer Intensive! I understand that violations of this policy may result in a loss
of access to computers and Internet services as well as other disciplinary or legal action.

Name of student ________________________________________________

Student signature _______________________________________________

Date ____________________________

As the parent or legal guardian of the student signing above, I hereby grant permission for my son or
daughter to use the computers and Internet services provided by Virginia Commonwealth University
and the VCUarts Summer Intensive! I have read the stated Computer & Internet Acceptable Use Policy
and understand that individuals and/or families may be held liable for violations of this policy.
Violations may result in a loss of access to computers and Internet services as well as disciplinary or
legal action. Acknowledging that some materials on the Internet may be objectionable, I accept the
responsibility of helping to convey appropriate standards for my son or daughter to follow when
selecting, sharing, or exploring information and media.

Parent/guardian signature____________________________________________

Date ____________________________

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 2007 VCUarts Summer Intensive!

Application Checklist:

Please use the list below to carefully check off each item to be certain
that your application is complete BEFORE sending it in.

□ Signed application
□ $50 non-refundable application fee
□ Medical Information/Release Form (completed and signed)
□ Attach immunization record and indicate approximate date of last tetanus shot.
□ Attach a copy of the front and back of your insurance card.
□ Teacher Recommendation (completed and signed)
□ Essay (for Visual Arts and Design applicants only)
□ Resume (for Theatre and Dance applicants only)
□ Computer and Internet Usage Agreement (completed and signed)
□ Did you check a box regarding on campus housing vs. commuting on page 1?
□ Did you check a box regarding whether or not you will need a parking space reserved on
campus on page 2?

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