Culley'sOffice	Stage Manager Fellowship Application	Fellowship Information Page
San Jose State University Television, Radio, Film and Theatre Department		May 2003

Name _________________________________________

SS# _______ - _____ - __________ Date ______________

Local Address _____________________________________________

________________________________________ ZIP _____________

Permanent Address ________________________________________

________________________________________ ZIP _____________

Phone (day)_________________ Phone (eve) __________________

Major ____________________ Transfer from __________________

Units completed ____________ Units this semester______________

Anticipated graduation date ________________________________

List four productions on which you have worked:

Title / Role	Production	Company/School	Dates
____________	________________________	__________________	________
____________	________________________	__________________	________
____________	________________________	__________________	________
____________	________________________	__________________	________

Your Academic
Advisors Signature: ____________________________ Date _______________

Revised: May 14, 2003 - J. Culley