Attaching your résumé is not a subs

Attaching your résumé is not a substitute for completing this form in full. Please type or print clearly.
CONTACT AND PERSONAL INFORMATION. Please type or write legibly.
Name ________________________________________________________________ Female Male
Last First Middle
Current Address ____________________________________________________________________________________
Street
____________________________________________________________________________________
City State Zip Code Country
Current Phone ____________________________________________________________________________________
Day Evening Mobile
E-mail ______________________________________________ Fax _________________________________
Permanent Address ____________________________________________________________________________________
Street
____________________________________________________________________________________
City State Zip Code Country
Permanent Phone ________________________________________
Date of Birth _____/_____/_____ Age (as of 7/1/13) _____ Social Security No. _____________________________
month, day, year
Country of Citizenship _______________________________ Visa Status (if not U.S. citizen) ________________________________
What is your hometown? (city, state and country, if not U.S.) ______________________________________________________
APPLICATION FEE
The $50 application fee is required of all applicants. This fee is not refundable and can’t be credited against any other charges.
Checks and money orders must be drawn on US banks in US dollars and made payable to: Moscow Art Theatre School USA.
Please send your application package to: MOSCOW ART THEATRE SCHOOL USA
1216 DENNISTON STREET
PITTSBURGH, PA 15217
Enclosed is the check/money order number __________ payable to the Moscow Art Theatre School USA.
Date ___________________________________________ Signature _______________________________________________
If you are under 18 years old, this form should be co-signed by your parent or guardian:
Name ______________________ Relationship to applicant __________________ Signature _____________________________
Over – application form continues on reverse