Summer 2012 Scholarship Application Form

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<ul><li><p>8/2/2019 Summer 2012 Scholarship Application Form</p><p> 1/1</p><p>Main Line Art Center Date of Application: ___________A. Applicant Information</p><p>_____________________________________________________________________________________________First Name Middle Initial LastName Sufx D.O.B*If Under 18 years of age</p><p>*If Under 18 years of age _______________________________________________________________________ Parent/Guardian Name Relationship to Applicant_____________________________________________________________________________________________</p><p>Address Apt # City State Zip code</p><p>(_____)_______-________ (_____)_______-_______ (_____)_______-________ ______________________Home Phone Work Phone Cell Phone E-mail</p><p>B. Financial Information of Applicant (or Parent of Applicant)Status (circle one) SINGLEMARRIED SEPARATED</p><p>Totalnumberofpeopleinthehousehold______Numberofdependents in the household ______</p><p>TOTALHOUSEHOLDGROSSINCOME*_______Below$15,000 (Pleasestateamount)_______$15,000-$25,000_______$25,000-$32,500_______$32,500-$40,000_______$40,000orabove(PLEASESTATEAMOUNT)$_________________________*Provideacopyofmostrecenttaxstatementorpaystub.</p><p>C.Registration</p><p>________________________________</p><p>ClassTitle(ex.CreatingTogether)</p><p>________________________________</p><p>Day&amp;Time(ex.Monday,1:30pm)</p><p>D.Check ListApplicationswillbedelayedifincomplete.Submissionofapplicationindicates</p><p>agreementtotheregistrationandscholarshippoliciesasoutlinedbyMainLineArtCenter. Includeallofthefollowingdocuments. Copyofmostrecenttaxformorpaystubforallcontributingadults. Completedregistrationformforoneselectedclass.(seeCofthisform) Personalletterexplainingyourdecisiontoapplyforscholarship.</p><p>Letter of support from a mentor or former teacher indicating your com-</p><p>mitmenttotheartsandthetotimetheclassrequires.</p><p>DateReceived:___/____/_______</p><p>DateApproved:___/____/_______</p><p>DateofContact:___/____/_______</p><p>ReceivedBy:</p><p>ApprovedBy:</p><p>ContactedBy:</p><p>Notes_______</p><p>_______</p><p>_______</p><p>MLAC USE ONLY</p><p>Summer 2012</p><p>(Adult Classes &amp; Teen Studios)</p><p>DEADLINE SEPT. 6, 2011</p><p>About ScholarshipsTheArtCenteroffersscholarshipopportunitiestostudents,adultsandchildren,whodemonstrateanancialneedandaninterestinthearts.Whileotherfactorsmaybetakenintoconsideration,scholarshipsarestrictlyassignedonthebasisofnancialneed.</p><p>DeadlineThedeadlineforsubmittinganapplicationisJune4,2012.Lateorincompleteapplicationswillnotbeconsidered.Submittinganapplicationdoesnotguaranteeaspaceintheclass.Fundsarelimitedandwillbedispersedonarstcome,rstservebasis.SummerCampscholarshipsrequireaseparateapplication.</p><p>EligibilityApplicantsmustbecomeMembersinordertobereceiveascholarship.Adultstudentswho</p><p>are registered for more than one course duringthesameclasssessionarenoteligibleforscholarships.However,familiesmayapplyfor</p><p>scholarshipsformorethanonechildwithinaclasssession.Eachstudentislimitedto2scholarshipswithinascalyear(summercampscholarshipswillbeconsideredseparately).</p><p>Applying for Scholarship*TobeconsideredforascholarshipalleldsofthebelowapplicationmustbecompletedandreturnedtotheArtCenteralongwiththefollowing</p><p>materials:arecenttaxformorpaystubforeachcontributingadult,aregistrationform,apersonalletterandaletterofsupport.*Please Note:Applicationswillbereturnedand/orpostponed,ifanyoftheaboveitemsaremissingorincomplete.</p><p>Processing ProceduresScholarshipswillbecollecteduntilthedeadlinedate,afterwhichallscholarshipswillbeviewedcollectively.</p><p>Payment Procedures</p><p>Scholarshipscovertuitiononly.Recipientsmayberesponsibleforsuppliesorsupplyfeesassociatedwiththeclass.Ifreceivingascholarship,anybalancemustbepaidatthetimeofregistration.Registrationmustbenalizedwithin5daysofnotice,failuretodosowillresultinlossofscholarshipandspaceintheclasswillnotbeheld</p><p>Registration Policies</p><p>Scholarships (and scholarship applications) cannotbetransferablefromoneclasstoanother(exceptinasituationwhereaselectedclassiscancelledbytheArtCenterandamountmaybeadjustedaccordingly).Scholarshipscannotbetransferablefromsemestertoanothersemester.</p><p>SCHOLARSHIP FORM: SUMMER 2012 (Adult Classes &amp; Teen Studios)</p><p>MailTo:Main Line Art Center</p><p>Attn:Registrar746PanmureRoadHaverford,PA19041</p><p>E.OptionalSurveyThe following is not required, but your answers will</p><p>assist us in serving you more effectively.1. What is the highest level of</p><p>education received in your household?</p><p>________________________________</p><p>2. Is there an adult in your household, that has been</p><p>unemployed in the last year? Y N</p><p>3. What is your race?</p><p>__________________________________</p><p>DEADLINE: JUNE 4, 2012</p></li></ul>