Youth Application Form

YOUTH

If you are interested in the Summer Youth Media program at Somerville Community Access Television, please complete the following form.

SAY Media! Summer Youth Program 2007
Application

July 10 - August 16 - Tuesdays and Thursday, Noon-4PM

Name:

Address:

City/State/Zip:

(open to Somerville residents only)

Phone:

Email:

Age in October ’06: School:
Grade: Sex: Male Female
Are you currently a SCAT member? Yes No

Your parent or guardian’s name:

Their phone:

What kind of media projects would you be interested in doing?
(Documentary, interviews, experimental, etc.) :

Do you have any video experience? :

Do you have any scheduling conflicts during the program? If so, when? :

Do you wish to be considered for a paid assistant position? :

APPLICATION DEADLINE June 30th, 2007

All sessions will take place on Tuesdays and Thursdays from Noon- 4PM.

If you have any questions, please contact Dacia Kornechuk, Youth Program Coordinator, at
membership@access-scat.org or call (617) 628-8826