Berridge Connect 2020

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Student Information

Full Name *

Birth Date * +

Grade

Street Address *

Address Line 2

City *

State

Province (Canada)

Zip/Postal *

Phone Number *

Email Address *

I am TEACHER (skip to school information and class choices)

YES

How did you hear about our program? *

Parent Information

Mother Full Name

Profession

Email

Cell phone

Father Full Name

Profession

Email

Cell phone

School Information

School Name *

Number of years attended

Street Address *

Address Line 2

City *

State/Province *

Zip/Postal Code

Country

Theatre/Film/Dance Teacher Contact Name

Email Address

Alternate Teacher Contact Name

Email Address

COMMUNITY PASS Choices

If you would like to fully enroll in the program with the COMMUNTY PASS please complete this section.

COMMUNITY PASS ($1495)

YES I want to enroll for the COMMUNITY PASS

I would like to be considered for a scholarship for up to 50% off the above cost (Please complete SCHOLARSHIP section of this form after you have made your class selections. Please note you may not apply for Refer a Friend AND Scholarship)

YES

Intended Major (Please only choose ONE) *

ACTING

FILM

Elective Choices (Choose 1. There will be an information session at the start of the program so these do not have to be your final choices) *

INTRO COURSES (Choose 2. There will be an information session on each one at the start of the program so these do not need to be your final choices) *

Give us an idea of your workshop interests (you are not enrolling just giving us an idea. Check all that might interest you) *

What you hope to get out of the program, your college goals or anything else you would like us to know about you:

SCHOLARSHIP INFORMATION

If you would like to be considered for a scholarship please enter your parents GROSS income for the 2019 tax year in the box below. Your scholarship award will be set according to your level of financial need.

If you are at a fee paying school you will need to be on scholarship at your school to qualify. Please enter the name and email address of the person to contact to verify your school scholarship

If there are circumstances around your scholarship request that you would like us to be aware of please let us know (ie change in family financial status not reflected in gross income)

CUSTOM PASS

If you are interested only in certain classes, please list them here and we will be in touch with you to complete your enrollment. Classes fees are $300/class, workshops are $40/session and private coaching is $40/session. Please note there is no access to community events, activities and offline resources with the Custom Pass.

ADDITIONAL INFORMATION

You will be notified of your acceptance into the program within 5-7 days. If you do not hear from us in this time frame please get in touch as we may not have received your application properly. An invoice for the full tuition amount will be emailed to you on acceptance and payment will be due in full within 10 days. If you have any questions about your application status please email Andrea Mardon, Artistic Director at andrea@berridgeprograms.com

All of the information you provide on this form is held in strict confidence and shared only with the Program Director and Associate Director. Your information is never given or sold to any third party service providers and will be deleted if you are not accepted into the program or choose not to participate in the program. Upon completion of the program you will be given the option for your email address to be retained by the program for the purpose of alumni communications only.