San Jose State University
Television, Radio, Film
and Theatre Department
Fall 2005 Media Lab Home
Name _________________________________________ Date ______________ Local Address _________________________________________ SS# _______ - _____ - __________ _______________________________________________________________
Permanent Address ______________________________________ Day Phone ()_________________ Cell Phone __________________ email : ________________________________________________
Major ____________________ Years in school _____________ Transferred from __________________ Units completed ____________ Units this semester __________ Anticipated graduation date _____________________ List Technical Theatre Courses completed or in progress. __________________________________________ ,
________________________________________________ and ________________________________________
List lighting and/or construction skills. (ie wood working, painting, welding, computer programs, light boards )
____________________________________________ , ________________________________ ,
_____________________________ and ____________________________________________ .
Note work related experience : __________________________________________________
___________________________________________________________________ .List two references: Teacher, __________________________ phone ____________
Personal : __________________________ phone ____________
Revised: Spring 2004 - J. Culley