Click Here to Download This Form MoCo Arts Scholarship Application Form Select Session Applying for Fall I Fall II Spring I Spring II Summer First Name Last Name Date of Birth mm/dd/yyyy Parent/Guardian Name (if under 18) Address 1 Address 2 City State Zip Code Home Telephone Cell Phone Work Phone Valid E-Mail Address Total Household Income LAST year Total Household Income THIS Year # of Members in Household Financial Assistance is for ONE class only (Maximum of 60% of class cost) *Please register with a deposit of $25.00, pending scholarship notification to secure a place in the class. This deposit will be applied to your class cost. Class Name, Day, & Time you wish to Register for How much tuition are you requesting? Are there any special circumstances that the Scholarship Committee should know about? Please supply one person we can contact for a recommendation Name Telephone Number How does this person know the applicant? Please write a brief letter about why you want to participate in classes at MoCo Arts. I want to attend classes at MoCo Arts because... Do we have permission to quote you, using first name only? Yes No A third part of the application will be mailed to you upon completion prior to the end of the session you have attended. All applicants who receive tuition assistance will need to express in writing what the class has meant to them. By submitting this form, you have verified that all above information is correct. All tuition assistance is awarded without regard to sex, race, religion, national origin or sexual preference. All information is confidential.
MoCo Arts Scholarship Application Form
Parent/Guardian Name (if under 18)
Total Household Income THIS Year
