8/2/2019 Summer 2012 Scholarship Application Form

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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