2012 High School Multimedia Conference Application

July 9th-11th
Personal Data: (please print)
Name: (Last) Address: (Street) Permanent Phone: Email: (City) Cell Phone: (State) (Zip) (First) (Middle)

Education:
(School): Year in School: Freshman Sophomore Junior Senior

Rank Multimedia Element Interests:

Photography Reporting Videography Social media Design Web

Equipment/Software Experience:
Adobe Creative Suite Video Equipment Camera Equipment iMac computer Associated Press Stylebook Other

Activities and Organizations:

Previous Media Experience:

Career Interests:

Employment History: (most recent position first)

Employer: Type of Business: City and State: Job Title and duties: Reason for Leaving: Dates of Employment: Supervisors Name: Phone:

Employer: Type of Business: City and State: Job Title and duties: Reason for Leaving:

Dates of Employment: Supervisors Name: Phone:

Employer:

Dates of Employment:

Type of Business: City and State: Job Title and duties: Reason for Leaving:

Supervisors Name: Phone:

PLEASE READ CAREFULLY - By inserting my name (as written above) in the text field below, I certify that the above statements are correct. I understand that any false information (or omissions) in the application, or its supporting documents, will be sufficient grounds for refusal of attendance to the conference. I further understand that the supervisors of this conference have the right to review my education, previous employment, driving and criminal records and other background data.

Applicants Signature

Date

Include with your application:

Letter of recommendation from a teacher Essay (500 words or less in length about why you would like to attend this conference and why you believe it will benefit you.)