Generating Momentum: Music Video Project Application FormDecember 2012 - February 2013

Winnipeg, MB MCIC302 - 280 Smith St.

Winnipeg, MBR3C 1K2

Phone: 204-987-6420Fax: 204-956-0031

www.mcic.caMCIC is looking for 8 talented high school students to collaborate with industry professionals to create a music video about global issues. The video will be created over two days in December 2012 and premiered during International Development Week, February 2013. The finished video will be available to students to use in their schools and communities to raise awareness and will be posted on YouTube.

Contact InformationName:

School:

Address:

Province:

Postal Code:

Teacher Contact:

Email:

Phone:

Special Needs:

Skills

Email:

Dance

Design

Activism

Music

Please describe your skills in the areas selected above..

Why do you want to participate in this project?

Instrument(s)

Dietary Needs:

I have skills in the following areas:

I can be available between 9:00-5:30pm on December 12th and 13th, 2012; and for one additional day in Feburary 2013 (date TBA)

It is extremely important that participants in the project be available for the following dates.

Availability

Phone:

Writing

Please submit this form via e-mail (using the submit button above) or print it and fax it to MCIC at (204) 956-0031 before November 5th, 2012.