Lights! Camera! Access! 2.0 2016 Application Resume Review, Speed Interview, Flash Mentoring and Mock Interview Media Summit November 14, 2016 in Washington, DC from 10:00 am – 2:00 pm

Attach: 1) your resume, and 2) one-page response to the following: Please explain your interest in media and how your personal experience with disability makes you a good candidate for the LCA 2.0 Washington, DC Disability and Media Summit.

Applicant Information Full Name: Date: Last First M.I.

Address: Street Address Apartment/Unit #

City State ZIP Code

Phone: Email:

Are you a citizen of the United YES NO If no, are you authorized to work in the U.S.? YES NO States?

Have you applied for similar YES NO If yes, where and when? ______recruitment events in the past?

Are you a Veteran of Military NO YES NO Are you at least 18 years of age? YES Service?

Education & Interests

University: ______Location:______

Current Academic Freshman Major: ______Status: Sophomore GPA:______Junior Senior Graduate Student Recent Graduate

Area(s) of Interest: Television Film Directing Check all that apply News Public Relations Digital Media Marketing Acting/Performing Production Writing Theatre Interactive Games Advertising Animation Other: ______Referral Source & Accommodations

How did you hear about the event?

Check all that apply Internet/Job Board Veteran Service Organization College/University Agency Recruiting Event Vocational Rehabilitation

LCA 2.0 Partners: CUNY National Disability Mentoring Coalition EIN SOF Communications SIGNmation Loreen Arbus Foundation DisBeat Deaf Film Camp NY Women in Film & Television PolicyWorks Gallaudet

Accommodation request: ______

Return all application materials to [email protected] & [email protected] by Wednesday, November 10th, 2016 at 12:00 PM ET