Cudamani: Gamelan Music & Dance Summer Institute

Application Form

June 25 - July 14, 2012
www.cudamani.org

Last Name: *

Middle Name: *

First Name: *

Address: *

City: *

State: *

Zip Code: *

Country: *

Business Phone: *

Home Phone: *

Fax:

Email: *

Website:

Date of Birth (m/d/y): *

Gender: *

Country of Citizenship: *

What is your native language?: *

Occupation: *

Select the program session you wish to attend.: *

June 25 - July 14, 2012 (Three-week program. Recommended.)

June 25 - July 6, 2012 (Two-week beginner program. Okay for beginners.)

July 2 - July 14, 2012 (Two-week intermediate program. Intermediate to advanced students only. Prior approval required.)

Area of Interest in the summer institute. MUSIC or DANCE. Choose one.: *

Please summarize your statement of interest below in 250 words or less. Include reasons for wanting to participate in this prog: *

Reference: Name of Individual who can comment on your experience and training in music and or dance. : *

Title/ Affiliation: *

Reference Contact Info: *

Work Sample: Submit a website OR mail to UCLA Center for Intercultural Performance. Glorya Kaufman Hall. 120 Westwood Plaza, Ste 188. Los Angeles, CA 90095:

How did you learn about this program?: *