Scholarships Form Student first name* Student last name* Student birthdate* MM slash DD slash YYYY Student street address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Student school Student grade First name of parent / guardian* Last name of parent / guardian* Birth date of parent / guardian* MM slash DD slash YYYY Select County*Chemung CountySteuben CountySchuyler CountyTompkins CountyPhoneEmail* Employer* Length of employment* Annual Income of all adults living in household*(before taxes are deducted)Number of dependents in household*Number of Unemployed Adults in Household*If you applied last year, how much was your award?* If you received an award last year, which classes did you attend? If a full award is not received, what portion of the tuition would you be able to pay each month?* Are there any circumstances you feel we should know of when considering your application? Please provide information:* To help us understand more about your connection to the arts, please select and then write about one (1) of the following topics in the "Student Paragraph" field below.* Describe a significant music or arts related experience in your life and describe the impact it had on you. Who has been your most significant influence? Describe the most challenging obstacle you have had to overcome; tell us what it helped you learn. Student paragraph*Please write about the topic you selected aboveAbout You - Student*Please tell us about yourself - Describe your extracurricular activities and interests – what do you do in your spare time? :About You - Student*Describe the skills you have developed by participating in your extracurricular activitiesAbout You - Student*List your volunteer activities and why they are meaningful to youAbout You - Student*Provide details about your home/family responsibilitiesAbout You - Student*Describe additional ways you contribute to your communityNomination Letter #1*Upload a Nomination Letter from an individual NOT related to you.Max. file size: 2 GB.Nomination Letter #2*Upload a Nomination Letter from an individual NOT related to you.Max. file size: 2 GB.Discipline (Select One)* Dance Visual Arts Ceramics Fencing Language Culinary Violin/Viola/Cello/Bass - Private Music Instruction Piano - Private Music Instruction Saxophone/Clarinet - Private Music Instruction Percussion - Private Music Instruction Flute - Private Music Instruction Voice - Private Music Instruction List the classes you would like to attend 9/1/2021 through 8/31/2022*If awarded, I commit to fully attending all classes.* Yes If awarded, I understand that failure to attend and/or participate in enrolled classes may result in the forfeiture of funding.* Yes Following the completion of my study, I will provide a written evaluation, or paragraph, describing my experience.* Yes I am willing to participate in a performance/exhibition, either on my own or with other recipients.* Yes Please check one of the following* I received a scholarship last year and fulfilled all of the requirements associated with the award. I did not receive a scholarship last year. I declare that I have completed this form, and to the best of my knowledge, I believe it to be true, correct and accurate. I have filled in ALL fields and uploaded all required information.*Please TYPE parent/guardian full name, and today's date: Website/URL EmailThis field is for validation purposes and should be left unchanged.
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