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Regent Hollywood Experience

Application for Regent Hollywood Experience
Application Deadline January 28, 2016


You must fill this form out completely.* Comments optional.

Application Request

  2. Male

  3. Yes


  5. Graduate:

    SSW510 (preferred)

  6. Undergraduate:


  7. Short film script or television script
    Feature film script in lieu of short film script or television script

  9. Regent University students please answer the following questions.

  10. School of Business & Leadership
    School of Communication & the Arts
    School of Divinity
    School of Education
    School of Government
    School of Law
    School of Psychology & Counseling
    School of Undergraduate Studies

  11. Distance

  12. For Credit

  13. Yes


    Regent University
    School of Communication & the Arts
    Attn: Margie Ackerman
    1000 Regent University Drive, COM 240
    Virginia Beach, VA 23464
    Fax: (757) 352-4291
  17. Participants

    I understand that all applicants must go through the approval process before they can be accepted into the program. Regent students confirmed to be in good standing by Student Services and the Business Office will be permitted to attend this course if they are accepted.
  18. Health Insurance for all Participants

    I am 100% responsible for securing my own medical coverage prior to the travel date.  I am responsible for any medical emergency and expense during this trip. I should take a copy of my insurance card when traveling.
  19. Travel Release Form

    I have reviewed, completed and signed the Regent University Travel Release Form. I will forward a copy of the completed form to Margie Ackerman by April 1, 2016.
  20. Photo Release Form

    I grant Regent University the right to take pictures of me and my property and to use such photographs as publicity, illustration, advertising and Web content. I will forward a copy of the completed Photo Release Form to Margie Ackerman by April 1, 2016.
  21. Minimum Number of Participants

    I understand that unless a minimum of 10 applications with deposits have been received by the deadline of January 28, 2016, the trip will be cancelled and a full refund of the program fee will be issued to me.
  22. Health Advisory & Special Accommodations

    I understand that this program can be rigorous, and some of the events may require demanding physical activities. Therefore, participants should possess the ability to:

    1. 1. Walk one mile without resting. Students walk to & from class each day, approximately 1 mile each way.
    2. 2. Stand for 30 minutes without sitting
    3. 3. Climb three flights of stairs without assistance. Park LeBrea Apts. have been known to have elevators break down. Each building has 12 floors.
    4. 4. Hear instructions in a group setting with environmental noise present
    5. 5. Read and understand written instructions and signs
    6. 6. Step in and out of buses or shuttles
    7. 7. Endure smog in various areas

    Regent University may be unable to provide special accommodations for people with disabilities. Any person who believes he/she may need special accommodations must contact the Disability Services Coordinator to discuss his/her needs in advance, with ample time to make appropriate accommodations as needed. If a person needs personal assistance during the trip, that person must bring a companion/assistant at full price. If I have any questions regarding special accommodations for people with disabilities, I will contact Adam Williams at 757-352-4894 or at
  23. Liability

    Regent University does not assume liability for injury, damage, loss, accident, delay, or irregularity which may be occasioned by reason or defect, through the acts or defaults of any company or person engaged in conveying the participants of this tour or in carrying out the arrangements of the tour, or as direct or indirect results of acts of nature, breakdowns in machinery or equipment, acts of governments or other authorities, de jure or de facto, wars, whether declared or not; hostilities, civil disturbances, strikes, riots, theft, pilferage, epidemics, quarantines, medical or customs regulations, loss or damage resulting from improper passports, visas, or other documents or from any causes beyond the control of the University. The University can accept no responsibility for loss or additional expenses due to delay or changes in schedule or other causes. We have the right to refuse to accept or retain any tour participant should such person's health or general deportment impede the operation of the tour to the detriment of other participants. All rates are based on tariffs in effect at the time the tour was planned and are subject to change in the event of adjustments therein. Baggage is carried at the owner's risk and baggage insurance is recommended. The issuance of tickets and vouchers will be deemed to be consent to the above conditions.

    The participant's signature below (type your name) and participation in this trip constitute acceptance of this provision and agreement by such participant that Regent University shall not be liable or responsible in any way whatsoever for any inconvenience, loss, damage, or injury arising out of or in connection with such tour services. By typing my name below, I acknowledge that I have read and fully understand the conditions and responsibility area of the enrollment application and verify the information I have provided as truthful and correct.

    Type Name:*


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