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Please type or print:
Name:
 ____________________________________________________ 
Gender:
_____ Male _____ Female
(First) (MI) (Last)
Date of birth:
 _____________________________ 
Student I.D. #:
 ____________________________ 
 Class year: _____ 
Junior _____ Senior _____ 
 
Graduate
Overall GPA:
 ________ 
Major GPA:
 ________ 
Expected date of graduation:
 ______________________________________________________________ 
Present address (
Good until
 _____/_____/_____):
Permanent address:
 _________________________________________ ________________________________________  _________________________________________ ________________________________________  _________________________________________ ________________________________________ 
Phone: ( )
 ____________________________ 
Phone:
( )____________________________ 
E-mail address:
 __________________________________________________________________________ 
In case of emergency, notify:
 _______________________________ 
Phone: ( )
 __________________ 
 Cell phone: ( )
 ____________________ 
Email address:
 _____________________________________ 
Major:
 ___________________________________ 
Concentration:
____________________________ 
SIUC department:
 ________________________________________________________________________ 
Studies Program in which you are interested:(If you check more than one city, please rank them by 1 for first choice, 2 for second choice, etc. If youare selected for the Studies Programs, you will have to choose a city within a week after your selection.)
 _____ Hollywood _____ Chicago _____ New York _____ Nashville _____ Washington, D.C.
Under the category for the Studies Program in which you are interested, please indicate your first twochoices for a potential internship in a media-related field. (Example: First choice: Cinema production;Second choice: Screenwriting.)Hollywood Studies:
First choice: ______________________________________________________________________________ Second choice: ___________________________________________________________________________ 
Chicago Studies:
First choice: ______________________________________________________________________________ 
APPLICATIONCMCMA Studies Programs
 
Department of Radio/Television, Department of Cinema & Photography, and School of JournalismSummer 20
1
0
 
Second choice: ___________________________________________________________________________ 
New York Studies:
First choice: ______________________________________________________________________________ Second choice: ___________________________________________________________________________ 
Nashville Studies:
First choice: ______________________________________________________________________________ Second choice: ___________________________________________________________________________ 
Washington, D.C. Studies:
First choice: ______________________________________________________________________________ Second choice: ___________________________________________________________________________ 
Experience, skills, interests, training (including courses) that might bear on your contribution to theprogram:
(If listing courses, please
describe
the course content, rather than list the course number)
  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________  ________________________________________________________________________________________ 
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