Scholarship Application
Phoenix Theatre Summer Camp Scholarship Application Summer 2015 Dear Campers & Parents: Through the generosity of our donors, Phoenix Theatre is pleased to offer scholarships for campers with challenging economic needs. Since the availability of scholarship money is extremely limited and will cover only a portion of the cost to attend Phoenix Theatre Summer Camps, we have implemented a new application process to ensure that available funds are distributed as fairly as possible. If you feel you need scholarship assistance, please carefully review and complete the following application to be considered for a scholarship (incomplete applications cannot be considered). Please note that scholarship awards may only be applied to the direct cost of camp attendance and may not be applied to pre or post camps, t-shirts or other products and/or services that may be offered. Steps: 1. Campers: Complete page one by writing or typing your answers in the spaces provided. 2. Parents/Guardians: Complete pages two and three by writing or typing your answers in the spaces provided. 3. Sign, date and return the 3 pages to Phoenix Theatre by April 15, 2015: Sydney Kreuzmann Phoenix Theatre 100 E. McDowell Rd Phoenix, AZ 85004 Email/Scan: [email protected] Fax: 602-889-6323 Today’s Date____________________ Camper Name________________________________________ Date of Birth________________ School Currently Attending_____________________________ Age on first day of camp_______ Current Grade Level_______________ 1. a) Have you attended a Phoenix Theatre Summer Camp before? ______________________________________________________________________________________ 1. b) What did you learn or discover at this camp? (If you answered ‘no’ to question 1(a) please skip to question number 2) ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 2. Why do you want to attend Phoenix Theatre Summer Camp this year? ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ __________________________________________________________________________________ ______________________________________________________________________________________ ____________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ________________________________________________________________________________ Camper Signature: _______________________________ Date: ___________________ Page 1 of 3 Parent/Guardian Name______________________________________________________________ (please print) Currently Employed?__________ Relationship to Camper________________________________ Spouse Name (if applicable)___________________________________________________________ Currently Employed?__________ Relationship to Camper________________________________ Primary Address___________________________________________________________________ Street Address Apt # City_________________________ State_______ Zip Code___________ Phone Number____________________________ Alt Phone Number__________________ Email____________________________________ Alt Email__________________________ Annual Household Income: (please check one) Total Number Living in Household: _____________ $0.00 - $19,999 $20,000 - $29,999 $30,000 – $39,999 $40,000 - $49,999 $50,000 - $74,999 $75,000 + Why are you requesting a scholarship for Phoenix Theatre Summer Camp? ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Please list the dates your dependent(s) will be attending: _____________________________________________________________________________________ _____________________________________________________________________________________ What kind of experience are you hoping will be provided to your child through Phoenix Theatre Summer Camp? ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Page 2 of 3 How would this scholarship benefit your camper and your family? ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ How did you hear about Phoenix Theatre Summer Camps? ______________________________________________________________________________________ ______________________________________________________________________________________ How may we contact you regarding your Summer Camp Scholarship? ______________________________________________________________________________________ ______________________________________________________________________________________ Anything else you would like to tell us? ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ How much would be a feasible (total) contribution from you? $_______________________________ I have completed all applicable information requested accurately and to the best of my ability. I understand that completion of this application does not automatically qualify me for assistance. Requests are subject to review based on need and availability of scholarship funds. Parent(s) Signature: ______________________________________ Date: _____________ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------Please return application to Phoenix Theatre no later than April 15, 2015. Email to: [email protected] Fax to: 602-889-6323 Mail to: 100 E. McDowell Rd, Phoenix AZ 85004 You will receive notification if you are awarded scholarship money by May 1, 2015. Thank you for your patience. Please direct all questions to Sydney Kreuzmann at 602-889-5293 or [email protected]. FOR OFFICE USE ONLY: Date Received ____________________ Page 3 of 3 Scholarship Amount Awarded __________________________________________ Acceptance? ________________________________________________________
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