8/6/2019 Fall Session Scholarship Form
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Main Line Art Center Date of Application: ___________
A.Applicant
Information_____________________________________________________________________________________________First
Name Middle Initial Last Name Suffix .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
. Financial Information of Applicant/Parent of ApplicantStatus
circle one) SINGLE MARRIED SEPARATEDNumber of Dependents (if
applicable) ______
TOTAL HOUSEHOLD GROSS INCOME *_______ Below $15,000 (Please
state amount)_______ $15,000 - $25,000_______ $25,000 -
$32,500_______ $32,500 - $40,000
$40,000 or above(PLEASE STATE AMOUNT) $
________________________* Provide a copy of most recent tax
statement or pay stub.
. Registration
________________________________
________________________________
lass Title ex. Creating Together)
________________________________
Day & Time (ex. Monday, 4:15 p.m.)
$________+ $______ = $__________
Tuition Fee Total
.Check Listpplications will be delayed if incomplete. Submission
of application indicates
agreemen o he reg s ra on an scho arsh p po c es as ou ne byMain
Line Art Center. Include all of the following documents. py of most
recent tax form or pay stub.
mpleted registration form for one selected class. (see C of this
form)
rsonal letter explaining your decision to apply for
scholarship.
Letter of support from a clergy person, mentor or former teacher
indicat-
ing applicants commitment to the arts and the to time the class
requires.
Date Received: ___/____/_______
Date Approved: ___/____/_______
Date of Contact: ___/____/_______
Received By:
Approved By:
ontacted By:
Notes______
______
______
MLAC USE ONLY
Fall 2011
DEADLINE SEPT. 6, 2011
About Scholarshipshe r en er o ers scho arsh p oppor unities
to
students, adults and children, who demonstratea financial need
and an interest in the arts.While other factors are taken into
consideration,scholarships are strictly assigned on the basis
offinancial need.
DeadlineThe deadline for submitting an application isSept. 6,
2011. Applications submitted beyondthe deadline date will not be
considered. If allapplication materials are not received on time
thescholarship cannot be granted. Space in class maynot be held
while application is in process. Funds
are limited and will be dispersed on a first come,first serve
basis.
EligibilityIf you are already enrolled in a course, you maynot
submit a scholarship for any additionalourses within the semester
the scholarship is
granted. Likewise you can not register for a classafte accepting
a scholarship within the samesemes er. You may not apply for
scholarship morethan two semesters with in a fiscal year. You
canapply for scholarship for more than one chil .
Applying for Scholarship*To be considered r a scholarship all
fields ofthe enclosed application must be completed
and returned to the Art Center along with thefollowing
materials: a recent tax form or pay stub,a registration form, a
personal letter and a letterof support. *Please Note: Applications
will bereturned and/ or postponed, if any of the aboveitems are
missing or incomplete.
Processing ProceduresScholarships will be collected until the
deadlinedate, afterwhich all scholarships will be
viewedcollectively.
Payment ProceduresScholarships cover tuition only. Recipientsare
responsible for any supplies or supply feesassociated with class.
If receiving a scholarship,any balance must be paid at the time
ofegistration. Registration must be finalized within 5
days of notice, failure to do so will result in loss
ofscholarship and s ace in class will not be held.
Registration PoliciesScholarships (and scholarship applications)
canot be transferable from one class to another
except in a situation here a selected class isancelled by the
Art C nter and amount may be
adjusted accordingly). Scholarships can not beransferable from
semester to another semester.
SCHOLARSHIP FORM: FALL 2011 SESSION
Mail To:Main Line Art Center
Attn: Registrar746 Panmure RoadHaverford, PA 19041
.Optional SurveyThe following is not required, but your answers
will
assist us in serving you more effectively.. 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?
_______________________________
