Students, please fill out this form in its entirety, and submit NO LATER than November 3, 2014.

All fields required

Your Name:


Name of College:

Your Campus Phone:

Your Cell Phone:

Your Email:

Are you available to attend the Regional Festival at Cleveland State University for the entire week (Jan 2 - 6, 2015)?:  Yes No

Scene Selected: (from list of scenes provided)

Are you an Irene Ryan Nominee or partner? Yes No Don't know yet 
Are any of your actors Irene Ryan Nominees or partners?: Yes No Don't know yet 

Name of Nominating Faculty Member:

Faculty Member Email: (required)

Faculty Member Phone:

For questions or further assistance please contact

Region II SDC Coordinator:

Arthur Adair
Queensborough Community College/CUNY