Theatre Ambassadors Program Recommendation Form
Park Square Theatre
Mary Finnerty, Director of Education
Emilie Moravec, Education Sales and Services Manager
Email: education@parksquaretheatre.org Phone: 651-291-9196 Fax: 651-291-9180
Applicant: Complete Part I and then give this form to each teacher who is recommending you. Please print or type
the information.
Part I: Applicant Information
_____________________________________________________________________
First, middle, and last name of applicant
Grade
as of 9/1/14
10
11
(circle one)
12
__________________________________________________________________________________________________
School name
Street address
__________________________________________________________________________________________________
City
State
Zip code
__________________________________________________________________________________________________
Applicant Phone Number
Please check one:
_____ I waive my right of access to any information contained in this evaluation.
_____ I do not waive my right of access to any information contained in this evaluation.
_________________________________________________________________________________________________
Applicant’s signature
Date
APPLICANT—DO NOT WRITE BELOW THIS LINE__________________________________________________
Part II: Evaluator Information
__________________________________________________________________________________________________
First Name of Evaluator
Last Name
Position and title
__________________________________________________________________________________________________
Evaluator’s Institution Name
__________________________________________________________________________________________________
Evaluator’s Institution Address
City
State
Zip code
__________________________________________________________________________________________________
Evaluator’s telephone # (with area code)
Evaluator’s e-mail address
Part III: The Evaluation
To the Evaluator: This recommendation is for the use during the selection process for the Ambassadors Program and will
not be shared outside the evaluation committee. A missing letter may disqualify or delay review of the application.
Please return the completed recommendation form by May 16, 2014 to:
Mary Finnerty Park Square Theatre 408 St. Peter Street, Suite 110 St. Paul, MN 55105
By Fax at 651-291-9180 or By Email education@parksquaretheatre.org
We appreciate your contribution.
Theatre Ambassadors Program Recommendation Form:
Applicant Last Name:_____________________
1. Briefly describe your contact with this student. Include classes the student may have taken, extra-curricular
activities, and theater arts education.
2. How well does the student work independently?
______Excellent
_____Above average
_____Average
Comments:
3. Please rate the student’s leadership ability.
______Excellent
_____Above average
_____Average
Comments:
4. Please rate the student’s artistic creativity and initiative.
______Excellent
_____Above average
_____Average
Comments:
5. Please rate the student’s dependability, reliability.
______Excellent
_____Above average
Comments:
_____Average
Applicant Last Name:_____________________
6. Describe evidence of extraordinary interest, ability, or achievement in the areas of theater arts.
7. Additional Comments: Careful selection is crucial to this program. Please add any specific observations you
have about the applicant, particularly the student’s unique qualifications as a potential Theatre Ambassador at
Park Square Theatre.
Overall Rating:
____Strongly recommend
____Recommend with reservations
____Do not recommend
______________________________________________________________________________________________
Signature
Date