KCACTF Region V

LMDA/KCACTF National Dramaturgy Award

ATHE Regional Dramaturgy Award

I would like to be considered for:

Student Dramaturg

First Name:

Last Name:

Student's Mailing Address:

Street:

City:

State: Zip:

Student's Phone:
Student's Email:
College/University:
Faculty Advisor's Name:
Faculty Advisor email:
Faculty Advisor Phone:
   
Production Title:
Director's Name:
Dates of Production:
   
If you are applying for the ATHE Region V Dramaturgy Award, Please select one:

This is a class project in this class: .

This is a project for an unrealized production.

This information if verified by this department chair, vouching that the information on this form is accurate and true.

Chair's Name:

Chair's Email:

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