Title:	Dr. Miss Mr. Mrs. Prof. Sir	First Name:		Middle Initial:
Last Name:		Suffix:	Esq. II III IV Jr. MD. PhD. Sr.
Address:		City:		State:
Zip:		Country:
Address while at ATW:(If different than above):		City:		State:
Zip:		Country:
Home Phone Number:		Cell Phone Number:		Business Phone Number:
NY Area Phone Number:		Fax Phone Number:		Email*:
Alt Email*:		Skype ID:		IM:
IM Network:	AOL Messenger Google Talk ICQ IRC MSN Messenger Yahoo Messenger	Birth date (mm-dd-yy:
* Please note that we have encountered problems sending information to Hotmail and AOL accounts, if you have an account with one of these internet providers please add our email address: outreach@actorstheatreworkshop.com to your address book in order to ensure that you receive emails from us.

Emergency Contact Information: Name: Relationship: Address: Phone Number: Email: References Please list two references we may contact; at least one should be professional supervisor from a current or former job, internship or volunteer position. For recent graduates and applicants attending school, in the third column please include the name and contact information of your Academic Advisor/Professor as a reference. Name: Name: Name: Relationship: Relationship: Relationship: Title: Title: Title: Company Name: Company Name: Company Name: Phone Number: Phone Number: Phone Number: Email: Email: Email: Are you a US Citizen? If not, what country(s) are you a citizen and what is your legal status in the US? How did you hear about us? Flyer/Poster Internet Flyer Email ATW Newsletter Search Engine Web Service ATW Event Other Event Ad Other Please be as detailed as possible below, as it will greatly assist in our outreach efforts. For instance, if this was through the Internet, please list the web site and search engine below. Did someone personally refer you to us? If so, who?

Did someone personally refer you to us? If so, who?

Are you currently studying acting or working with an acting coach? If so, where and with whom?

In preparation for the interview, and so we may begin to get to know you, please answer the following questions. These questions are meant to challenge you creatively and to address some of the issues that unfold throughout the creative process. 1. Please describe your professional background and current responsibilities (in acting and other professional work you are involved in)? 2. What are your central accomplishments as a professional and as a person? 3. Are you prepared to open up to new discoveries and possibilities about yourself and the world? Are you ready to give yourself time to develop these possibilities and to commit to a process of learning? 4. What long - term process have you previously been committed to outside of your professional responsibilities? Are you committed to yourself as a human being? 5. What is your ideal in life? What do you want to accomplish? 6. What quality in yourself do you want to develop, and are you willing to go beyond what you perceive as your limitations? Each individual is endowed with unique creative talent and has a profound longing to contribute their creative essence to the world as something powerful, beautiful, and lasting. When one is aware of this insight, it can be painful to look back on life and realize you did not take the opportunity to develop your gifts. By joining the creative legacy and tradition of the theatre, what statement would you like to make professionally, artistically and philosophically with your trained instrument in the world? Please attach a current ACTING resume if available. Please attach a current WORK resume.

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The Actors Theatre Workshop, Inc. 145 West 28th Street, 3 Fl., New York, NY 10001 (212) 947-1386 | outreach@actorstheatreworkshop.com Copyright 2007.The Actors Theatre Workshop. All Rights Reserved.