summer 2012 scholarship application form

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  • 8/2/2019 Summer 2012 Scholarship Application Form

    1/1

    Main Line Art Center Date of Application: ___________A. Applicant Information

    _____________________________________________________________________________________________First Name Middle Initial LastName Sufx D.O.B*If Under 18 years of age

    *If Under 18 years of age _______________________________________________________________________ Parent/Guardian Name Relationship to Applicant_____________________________________________________________________________________________

    Address Apt # City State Zip code

    (_____)_______-________ (_____)_______-_______ (_____)_______-________ ______________________Home Phone Work Phone Cell Phone E-mail

    B. Financial Information of Applicant (or Parent of Applicant)Status (circle one) SINGLEMARRIED SEPARATED

    Totalnumberofpeopleinthehousehold______Numberofdependents in the household ______

    TOTALHOUSEHOLDGROSSINCOME*_______Below$15,000 (Pleasestateamount)_______$15,000-$25,000_______$25,000-$32,500_______$32,500-$40,000_______$40,000orabove(PLEASESTATEAMOUNT)$_________________________*Provideacopyofmostrecenttaxstatementorpaystub.

    C.Registration

    ________________________________

    ClassTitle(ex.CreatingTogether)

    ________________________________

    Day&Time(ex.Monday,1:30pm)

    D.Check ListApplicationswillbedelayedifincomplete.Submissionofapplicationindicates

    agreementtotheregistrationandscholarshippoliciesasoutlinedbyMainLineArtCenter. Includeallofthefollowingdocuments. Copyofmostrecenttaxformorpaystubforallcontributingadults. Completedregistrationformforoneselectedclass.(seeCofthisform) Personalletterexplainingyourdecisiontoapplyforscholarship.

    Letter of support from a mentor or former teacher indicating your com-

    mitmenttotheartsandthetotimetheclassrequires.

    DateReceived:___/____/_______

    DateApproved:___/____/_______

    DateofContact:___/____/_______

    ReceivedBy:

    ApprovedBy:

    ContactedBy:

    Notes_______

    _______

    _______

    MLAC USE ONLY

    Summer 2012

    (Adult Classes & Teen Studios)

    DEADLINE SEPT. 6, 2011

    About ScholarshipsTheArtCenteroffersscholarshipopportunitiestostudents,adultsandchildren,whodemonstrateanancialneedandaninterestinthearts.Whileotherfactorsmaybetakenintoconsideration,scholarshipsarestrictlyassignedonthebasisofnancialneed.

    DeadlineThedeadlineforsubmittinganapplicationisJune4,2012.Lateorincompleteapplicationswillnotbeconsidered.Submittinganapplicationdoesnotguaranteeaspaceintheclass.Fundsarelimitedandwillbedispersedonarstcome,rstservebasis.SummerCampscholarshipsrequireaseparateapplication.

    EligibilityApplicantsmustbecomeMembersinordertobereceiveascholarship.Adultstudentswho

    are registered for more than one course duringthesameclasssessionarenoteligibleforscholarships.However,familiesmayapplyfor

    scholarshipsformorethanonechildwithinaclasssession.Eachstudentislimitedto2scholarshipswithinascalyear(summercampscholarshipswillbeconsideredseparately).

    Applying for Scholarship*TobeconsideredforascholarshipalleldsofthebelowapplicationmustbecompletedandreturnedtotheArtCenteralongwiththefollowing

    materials:arecenttaxformorpaystubforeachcontributingadult,aregistrationform,apersonalletterandaletterofsupport.*Please Note:Applicationswillbereturnedand/orpostponed,ifanyoftheaboveitemsaremissingorincomplete.

    Processing ProceduresScholarshipswillbecollecteduntilthedeadlinedate,afterwhichallscholarshipswillbeviewedcollectively.

    Payment Procedures

    Scholarshipscovertuitiononly.Recipientsmayberesponsibleforsuppliesorsupplyfeesassociatedwiththeclass.Ifreceivingascholarship,anybalancemustbepaidatthetimeofregistration.Registrationmustbenalizedwithin5daysofnotice,failuretodosowillresultinlossofscholarshipandspaceintheclasswillnotbeheld

    Registration Policies

    Scholarships (and scholarship applications) cannotbetransferablefromoneclasstoanother(exceptinasituationwhereaselectedclassiscancelledbytheArtCenterandamountmaybeadjustedaccordingly).Scholarshipscannotbetransferablefromsemestertoanothersemester.

    SCHOLARSHIP FORM: SUMMER 2012 (Adult Classes & Teen Studios)

    MailTo:Main Line Art Center

    Attn:Registrar746PanmureRoadHaverford,PA19041

    E.OptionalSurveyThe following is not required, but your answers will

    assist us in serving you more effectively.1. What is the highest level of

    education received in your household?

    ________________________________

    2. Is there an adult in your household, that has been

    unemployed in the last year? Y N

    3. What is your race?

    __________________________________

    DEADLINE: JUNE 4, 2012

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