2019 Application Form - Veterans Institute Film & Media

Name*

First Middle Last

Preferred Name or Nickname

Maiden Name (if applicable)

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Home Phone

Cell Phone

Preferred Method of Communication*

Email
Phone Call (Home)
Phone Call (Cell)
Text Message

Drivers License Number

Issuing State

Expiration Date

Do you have a CDL license?

Yes
No

CDL number

Have you ever been convicted of a felony?

No
Yes

If you have been convicted of a felony, please explain the circumstances here:

Service

Branch of Service

Date of Service (start)

Date of Service (end/until)

Type of Discharge / Separation

Attach a copy of your DD214 here:

File must be in PDF format, maximum file size of 2Mb.

If DD124 unavailable, please explain why

Duty Stations / Deployments:

Please list deployments here, using the mm/dd/yy date format for the start and end dates. Click on the 'plus' icon at the end of the row to add another entry.

Start Date	End Date	Duty Station / Campaign	Responsibilities (MOS/Brief description of duties)

Performance Evaluations

Please attach copies of your last two (2) military performance evaluations if you have them. If you do not, please provide contact information for your immediate supervisor in the space provided below.

Performance Evaluations (2)

Files must be in PDF format. File size should be no larger than 2Mb.

Drop files here or

If Performance Evaluation unavailable, please explain why

Supervisor(s)

Name & Rank of Supervisor	Current Duty Station of Supervisor	Phone Number	Email Address

Related Experience

Film, Theater, Digital Media

Do you have experience in film, photography, theater or digital media?

Yes
No

Briefly describe your experience

Essay

In the following area, please write an essay (no less than 300 words but no more than 500 words) explaining your interest in film studies and why you would like to participate in this program. If no essay, please explain why you are not providing one in the provided area.

If you can't submit an essay, please explain why

References

First Reference Name

First Last

Association (Personal / Professional)

Known from (Date)

Cell Phone

Home Phone

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Second Reference Name

First Last

Association (Personal / Professional)

Known from (Date)

Cell Phone

Home Phone

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Letters of Recommendation

Please attach two (2) Letters of Recommendation. If no recommendations, please explain why they are not provided. Files should be in PDF format, and should not exceed 2Mb in size.

Drop files here or

If References or Letters of Recommendation unavailable, please explain why

Session Information

Which session (dates) are you interested in?*

Session Beginning - (Application Open Dates)
May 6, 2019 - (1/2/2019 - 3/8/2019)
Sept. 9, 2019 - (5/13/2019 - 7/12/2019)

May 6—July 26, 2019
Sept. 9—Dec. 6, 2019

Are you currently employed?

Yes
No

Work Hours

Are you available to intern/be placed on a job site?

Yes
No

If so, what days and times are you available? (one day per line, please)

Available Day of the Week	Time Available

Additional Materials

Please attach copies of any additional items that support your application.

Examples include:
Resume
Medals received
Letters of Commendation
Files must be in PDF format, and cannot be larger than 5Mb.

Drop files here or

If you have questions, please review our FAQs or contact us directly.

Name

This field is for validation purposes and should be left unchanged.