PART A / STUDENT INFORMATION

Name:
Mailing Address:  
City: State:
Zip Code:
Telephone:
Message Telephone:
Fax:
E-mail:
High School:
School Phone:
Age:     Grade Level:     Gender: female male
Ethnicity:     Yup'ik/Cup'ik Athabascan Tlingit Aleut/Alutiiq Tsimsian Haida Inupiat/SLI Yupik Eyak
Other Alaska Native (Please specify):
Native American (Please specify tribe):

Are you enrolled in an Alaska Native Corporation? YES NO
If yes, the name of the corporation is:

Are your parents enrolled in an Alaska Native corporation? YES NO
If yes, the name of the corporation is:

How did you hear about this Institute?

Are you currently taking classes in broadcast or print?
YES NO None are offered

Have you worked on your school newspaper?
YES NO There is no school paper

Have you worked on your school yearbook?
YES NO There is no yearbook

Have you worked or volunteered at a radio station?
YES NO There is no local station

Have you worked or volunteered at a television station?
YES NO There is no local station

Have you worked or volunteered at a newspaper or magazine?
YES NO

What subject(s) do you like best in school?

What subject(s) do you earn your best grades in?

What books have you read in the past year?

What magazines do you read regularly?

PART B / ESSAY

Please submit a one page typed, double-spaced essay written under the supervision of a school official who will sign it certifying that you did the writing, and that it was not edited by anyone. If you have to write your essay in longhand, make sure it is legible. Focus on why you are interested in attending the Institute, and how you might benefit from attending. Please tell us what kinds of skills you have, or what skills you would like to learn that could be useful to a career in the media. Don't spend more than an hour writing the essay, and don't let it become a source of stress for you. Have fun with it!

PARENT / GUARDIAN / SCHOOL OFFICIAL who assisted you in completing PART B (Please provide the date they helped you and a phone number to reach them for verification):
Name:      Date:     Phone:

PART C / SCHOOL TRANSCRIPT and LETTER OF RECOMMENDATION

Please mail recent transcripts from your school AND a letter of recommendation from a teacher, counselor or principal to the address below before the deadline.

PART D / TRAVEL GRANT (Travel grants will be awarded to accepted students based on economic need.)

If selected to attend the Institute, would you be able to pay for your airfare?
YES NO

If selected to attend the Institute, would you be able to pay the $350 Institute fee (for tuition, etc.)? YES NO