Student Name: ____Rosemary Targosky___ Page A

Do not complete the application before reading this page.

1. Before completing the application, read all of the sections of the website. It’s important that you know
something about GSA before applying.
2. The first step of the application process is to be sure you meet the proper qualifications. Please click on the
Qualifications link on the website. You MUST have the qualifying grades to apply. You may apply for one
and only one arts area; however, instrumentalists may audition on up to two instruments.

3. If you meet the qualifications, the next step is to fill out the Student Application and the Consent Form

4. One part of the application is to be submitted online. The remainder is to be completed and submitted
by traditional mail.

5. Save the application (second part) to your computer as a Microsoft Word document and type directly on it.
You should type your name at the top of each page. In addition, the essay and your letters of
recommendation are to be typed.

6. Write the essay. This applies to all applicants. Directions are on page 2 of the application

7. Provide two letters of recommendation. One of the letters must come from a teacher who has worked with
you in your arts area (may be a private arts teacher) or who is familiar with your work. Letters should
clearly state the capacity in which the writer knows you, and the writer’s professional position. Letters
should be submitted on professional letterhead and are to be typed using a 12-point Roman or Arial font.
The use of fancy, italicized fonts is strongly discouraged. Writers should speak candidly about your work,
talent, desire, strengths and weaknesses.

8. Please pay careful attention to the parent/student signature page. If you have questions about the
residency and no-visitation requirements, you may direct them to [email protected].

9. Type the rest of the application, print it and take it to your counselor. The counselor will complete page 2 of
the application and give it to your principal for his/her signature. The counselor will also attach the
necessary school records and arrange the application in the correct order. Please remind your counselor
that your Social Security number is NOT to be sent with your transcript. It is your responsibility to go to
the Audition Schedule and Guidelines section to determine the audition requirements in your area
of expertise. Start preparing NOW.

10. Your counselor may mail your application; however, you are the one who is ultimately responsible for
mailing the entire packet to Sherry Keffer, Office of the Secretary of Education and the Arts, Building
5, Room 205, 1900 Kanawha Boulevard East, Charleston, WV 25305. It must be postmarked by
December 10, 2010.

11. You will receive an email telling you the time and place of your audition. If you do not have email, you will
receive a letter through the mail. It is important, therefore, that you check your email account regularly
during the first week of January. See audition section for more details.

My signature guarantees that I have read the instructions for applying and that I have familiarized
myself with the class content and the audition process for my discipline.

Student
Signature______________________________________Date:_______________________
 Student Application: 2011 Governor’s School for the Arts
Page 1 of 3

All student sections must be typed. Simply key the information into the empty fields. On page 2, the
counselor need not type.

PERSONAL INFORMATION
First Name Rosemary Middle Kate
Name
Last Name Targosky Nickname

Birth Date School

&County
Home Address City

State, ZIP Code Student’s E-

Mail
Names of Parents

F. Home Phone Cell Phone

Mother’s H. Phone Dad’s H. Phone

Work Phone: Mom Work Phone:

Dad
Check T-Shirt Size S__ M__ L__ XL__ Race
XXL___

Place an X beside the Arts Area For Which You Are Applying
Acting Creative Writing Dance
Instrumental Music STUDENTStudio/Visual
STATEMENT Art Vocal Music
Digital Media Art Instrument--
The
decision to apply for the Governor’s School for the Arts is my own. I want to participate fully in the
program. If selected, I will abide by the rules and expectations of the program and the program director
(dean). The responses contained in this application are my own work and are truthfully offered.

APPLICANT’S SIGNATURE DATE

Attach a 400-500 word composition that addresses your passion for the arts, especially the one for which you hope to
audition. Discuss the opportunities, or lack thereof, for furthering your interest and study in the arts in the area of the state
in which you live and in your school.. Students writing fewer than 400 or more than 500 words will be significantly
penalized. Type in 12 point Roman or Arial type, double-spaced.
Page 2 of 3 West Virginia Governor’s School for the Arts – Student Application Part II

To be filled out by the school counselor/principal and returned to the student.

Student
Name

1. A grade-point average of at least 2.5 OR A ranking

1. GPA _________ or
either in the top 50% of his/her class. This requirement
Class Rank ______/_________
cannot be waived.

(Check off #2-6)

2. A record of regular attendance/acceptable discipline
record
(It is not necessary to send the record itself; simply check 2. ______________
to denote that the record is acceptable.)

3. Two (2) Teacher recommendation letters are attached

to this application. One of the letters MUST address the
student’s ability and passion in the arts area for which
application is being made. Either or both letters may
3. ______________
come from private instructors. Both should address the
student’s likelihood to fare well with 99 other students
three weeks.

4. Includes application form, consent form, essay. Essay

should be at the end of the packet, just before the
4. ______________
transcript.

5. Photocopy of transcript of grades and attendance

record for grades 9 and first grading period of grade 10.
Please redact Social Security numbers if they still 5. ______________
appear on your transcripts.

6. Packet is stapled in the following order: 6. _____________

Application, Teacher recommendations, Essay;
School records
 Principal MUST check and sign the following statement for EACH applicant. If
student is recommended with reservation, an explanation must be attached.

I recommend the above-named student.

Without reservation
____________________

With reservation ____________________

______________________________ Signature

It is the responsibility of the student to mail his or her application. Although some counselors or administrators wish to do
the mailing, that is a courtesy and not a requirement.

Student Name:_____________________________________________________________

Page 3 of 3 West Virginia Governor’s School for the Arts – Student Application Part II

Student Name _____________________________________

Consent Form/ Student Application

I (we) give permission to the West Virginia Governor’s Schools to release the herein named student’s name, address,
and likeness to organizations or news media, including the Internet, that are interested in recognizing and/or supporting
scholarly efforts. Addresses may be sent to colleges and professional schools for recruitment. Student comments may be
published on the Internet, newspaper, radio or TV. I also give permission to the Governor’s Schools to publish contact
information submitted by my minor child to the alumni section of the Governor’s Schools website and for the student
directory.

Student Signature Date

Parent/Guardian Signature Date

I (we) agree to a full-time commitment for the duration of the Governor’s School for the Arts, July 3-23, 2011, including
evenings and weekends. If you are chosen for another honor during this period you must make a choice between
attending GSA or the other function. Leaves of absence will not be granted.
Parents: Your signature indicates that you support your son or daughter in this endeavor, that you will respect the
residential nature of the school, and that you will not attempt to visit.

Student Signature Date

Parent/Guardian Signature Date

I (we) agree to participate in and to abide by the regulations of the West Virginia Governor’s School for the Arts (See
website). Signatures also indicate an understanding that students who do not follow the rules will be sent home. Students
will wear a name tag whenever they are out of the residence hall, and a signature indicates the willingness to do so.
Students who repeatedly “forget” the name tag will be sent home. Your signature also indicates that you are aware that
GSA is an interdisciplinary experience and that students will not spend all of their time in the major discipline.

Student Signature Date

Parent/Guardian Signature Date

I give permission for the Department of Education and the Arts to collect the personal data required on the application.
The applications themselves will be transferred to the faculty of GSA for approximately two weeks for review/audition
purposes, after which they will be returned to the Office of Education and the Arts. Date collected from page that is
submitted online will be transferred to the Dean of GSA for the students who are ultimately selected. All electronic
transfers will be encrypted. Your agreement signifies that you are aware of this process. We always take precautions to
safeguard student records, and there has not been an incident with a security breach in Governor’s Schools applications.
More stringent rules regarding privacy have necessitated such a procedure.

Student Signature ____________________________________________Date ___________

Parent Signature _____________________________________________Date __________

Don’t forget to write the essay