Application Form for Miami Montage 2023
2023 PEACE SULLIVAN/JAMES ANSIN
HIGH SCHOOL WORKSHOP IN JOURNALISM & NEW MEDIA
University of Miami School of Communication
Application & Request for Information.
PROGRAM DATES: June 25 – July 8, 2023. THIS IS AN INTENSIVE PROGRAM. STUDENTS MUST BE PRESENT FOR EACH DAY, INCLUDING ANY HOLIDAYS. THERE IS LIMITED TIME-OFF ON SUNDAYS.
COMPLETE THIS FORM AND ATTACH THE FOLLOWING:
- A COPY OF YOUR LATEST HIGH SCHOOL TRANSCRIPT.
- A 200-WORD ESSAY ABOUT YOUR INTEREST IN THIS PROGRAM, EXPERIENCE AND REASONS FOR APPLYING. INCLUDE THE WORD COUNT. THIS ESSAY MUST BE YOUR OWN WORK.
- TWO EXAMPLES OF YOUR BEST WRITING AND/OR OTHER WORK YOU WANT US TO CONSIDER. THIS MAY INCLUDE VIDEOS, AUDIO, PHOTO, AND/OR ANIMATION. HOWEVER, YOU MUST IUNCLUDE ONE WRITING SAMPLE. YOU MAY SUBMIT BY ATTACHING HARD COPIES TO THIS APPLICATION OR BY EMAIL AS EXPLAINED BELOW.
- RECOMMENDATION LETTER: Include with the application or by separate email one letter of recommendation on official letterhead from a teacher, school counselor or advisor who is familiar with your skills, character, and interest in this workshop. If you do not provide this letter, we may reject your application.
PERSONAL INFORMATION REGARDING STUDENT APPLICANT (type or print legibly):
Full Name: __________________________________________ Date of Birth: ___________________
Primary Home Address: ______________________________________________________________
Mailing, if different from above: _________________________________________________________
Telephone (home & any cellular with area code): ___________________________________________
Applicant’s Email Address: _____________________________________________________________
Parent or Legal Guardian name, email address and phone: ___________________________________
___________________________________________________________________________________
Gender: ___ Grade Level at time of Application: ___
SCHOOL INFORMATION: Name of Current High School & Mailing Address: ______________________
____________________________________________________________________________________
School Telephone Number (Advisor or best contact): _________________________________________
School or Journalism Advisor: ___________________________________________________________
Describe your school or community-based journalism and similar experience (e.g., newspapers, magazines, television, radio, blogs, web pages, design, photography, etc.): _______________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Explain your specific leadership positions in any school or community-based journalism organizations, groups, or publications (printed, online, or broadcast) with relevant dates: ______________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Tell us about your specific skills or experience you wish us to consider: ___________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Parental Approval & Contact Information
A custodial parent or legal guardian must sign and approve this application and permission statement:
I, ______________________________, give permission for my child or dependent to attend this workshop at the University of Miami and at other sites (as reporting projects may require) in the South Florida area. My son, daughter, or dependent has my permission to participate in any field trips and reporting-related interviews or visits in the South Florida area. My son, daughter, or dependent also has my permission to spend the required nights during the workshop in University of Miami dormitories. I understand that the University of Miami assumes no liability for personal injuries or losses of any kind during the workshop period. I also understand that if my child or dependent is accepted, we may be required to complete additional forms (e.g., medical and publicity releases) and provide additional information as a condition of his or her participation; and, that if my child or dependent violates any University or workshop rules of conduct, he or she may be discharged from the program.
PRINTED NAME of Parent/Guardian: ____________________ Relation to Student: ______________
SIGNATURE: ________________________________________ Date: _________
Contact Information for Parent or Guardian (e.g., cell, work and home phone numbers AND emailaddress as well as home address, if different from what is list above): __________________________
____________________________________________________________________________________
____________________________________________________________________________________
Return this form with clips and attachments to:
Samuel A. Terilli, Co-Director
Sullivan/Ansin High School Journalism & New Media Workshop
University of Miami School of Communication-Rm. 2007
5100 Brunson Drive; Coral Gables, FL 33146
(305)-284-8451
sterilli@miami.edu
(IMPORTANT NOTES: You may send applications & materials by mail, hand-delivered or emailed, but we must receive everything on or before April 25, 2023. Illegible or incomplete applications may be disqualified. Please use a standard software program if you scan. All applicants must be available, if requested, for an interview on the UM campus as part of the application process at a date to be determined. All accepted applicants must be available for the entire workshop. We will announce acceptances on or about May 15, 2023, by email. Assume application materials will not be returned.)