Student Information

First Name :
Last Name:
If different from your legal name, what name do you go by?
Age:
Date of Birth: (mm/dd/yyyy)
Gender:
Student's Cell Phone:	( ) -
Student's E-mail:
Address 1:
Address 2:
City:
State:	NY AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code:
County:
Current Grade:

Parent/Guardian's Information

First Name:
Last Name:
Home Phone:	( ) -
Parent's Cell Phone:	( ) -
Parent's E-mail:
	Check this box if Student Address and Parent Address are the same.
Address 1:
Address 2:
City:
State:	NY AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code:

School Information

School Name:
Principal's Name:
School Phone:	( ) -
School Address:
City:
State:	NY AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code:
Art Director/Teacher:
Teacher's Phone:	( ) -
Teacher's E-mail:

Have you attended the School of Visual Arts in the past?	Yes No
How did you hear about NYSSSA?

Part II. Statement of Artistic Intent (to be completed by student)

Statement of Artistic Intent (to be completed by student) Please write a brief statement about your artwork and what you would like to learn from the NYSSSA School of Visual Arts:

In addition to submitting this online form the applicant acknowledges they must also attach a Portfolio Contents Form. Form(s) are available on the NYSSSA Website at: (Please note: Returnees are encouraged to submit a portfolio of no more than 5 recent works)
http://www.oce.nysed.gov/nysssa/visual-arts

I request mailed copies of NYSSSA correspondence (Please note: All student auditions results will be mailed to the address provided above)

Notes for Digital Portfoli0 Please share your digital portfolio via Dropbox or Google with nysssa@nysed.gov