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Mary Doctor Performing Arts Scholarship
A fund of Foundation For The Carolinas
MARY DOCTOR PERFORMING ARTS SCHOLARSHIP STUDENT APPLICATION FORM
SCHOLARSHIP AWARDS
On behalf of The Doctor Family Foundation and Blumenthal Performing Arts, Foundation For The Carolinas (“FFTC”) awards scholarships on the
basis of a competitive process that considers performing arts abilities or backstage skills, academic achievement, extracurricular and community
involvement, a statement of the applicant’s personal aspirations and educational goals, financial need, and references. Applicants are advised to
thoroughly review the guidelines for specific criteria relating to the scholarship for which they are applying. Scholarships are awarded at the discretion
of FFTC’s Board of Directors based on The Mary Doctor Performing Arts Scholarship Fund Committee recommendations. FFTC pays scholarship
funds directly to the recipient’s school. Scholarships are designated for tuition, required fees, books, supplies and school-related living expenses.
Scholarships are awarded for one year only. FFTC may consider renewal scholarships for one year each and may be renewed up to three times for a
maximum of four years of undergraduate study provided funds are available, the recipient enrolls full-time and the recipient maintains qualifying
criteria. Scholarships are awarded without regard to race, color, ethnicity, national origin, religion, gender or sexual orientation.
APPLICATION AND INFORMATION RELEASE STATEMENT
The information provided in my application is, to the best of my knowledge, complete and accurate. I understand that false statements on this
application may disqualify me from receiving a scholarship. Please complete this page online, print and submit along with other required
documents. Be sure to keep a copy for your records.
PERSONAL INFORMATION (*questions for data collection purposes only)
First Name:
Last Name:
Middle Initial:
Date of Birth:
Age:
Ethnicity* (Optional): Other
Please Choose
Permanent Street Address:
City:
County:
State:
ZIP:
Home Telephone:
Cellular Telephone:
Email:
Parent/Guardian Name(s) and Address(es)
Relationship:
High School (HS)**:
HS Weighted cumulative GPA/scale**:
HS Unweighted cumulative GPA/scale**:
Name the college or university that you would most like to attend:
List colleges or universities that have accepted you for fall 2015 enrollment:
List colleges or universities to which you have applied but have not yet received a response:
Desired degree and intended major:
COLLEGE FINANCIAL INFORMATION (information below must match information from 2015-2016 Student Aid Report (SAR)
Estimated Expenses
Tuition/Fees:
Room/Board:
Books and Supplies:
Transportation:
Misc. Personal Expenses:
TOTAL Expenses:
2014-2015 Application
$
$
$
$
$
$
$
Financial Assistance
Federal/State Grants:
Scholarships:
Work Study Program:
Loans:
Other
TOTAL Assistance:
$
$
$
$
$
$
$
2015-2016 SAR INFORMATION
# in household
# in college including you
AGI ( Adjusted Gross Income)
$
EFC Score (from SAR)
Do not change formatting.
Mary Doctor Performing Arts Scholarship
A fund of Foundation For The Carolinas
Applicant’s Name:
Last Name
First Name
Middle Initial
Briefly describe below your training and experience to date in the area of performing arts (more detail may be
included in your essay if you think appropriate):
List the extracurricular activities in which you have participated during your high school years—including community
service. Please indicate any leadership roles or responsibilities:
The Mary Doctor Performing Arts Scholarship Fund provides scholarships to high school seniors who demonstrate
financial need as well as ability and great interest in the performing arts. Please briefly describe how a scholarship
award would financially impact your ability to attend an institute of higher learning?
I verify that all information provided above is accurate
Applicant’s signature
2014-2015 Application
Date
Your responses should not exceed this page. Do not change formatting.
Mary Doctor Performing Arts Scholarship
A fund of Foundation For The Carolinas
Applicant’s Name:
Last Name
First Name
Essay
Consider carefully the following:
“Why I Am the Right Choice for the Mary Doctor Performing Arts Scholarship Fund”
Write an essay (no more than one page) in which you develop your position on this topic.
2014-2015 Application
Middle Initial
Page 1
Mary Doctor Performing Arts Scholarship
A fund of Foundation For The Carolinas
MARY DOCTOR PERFORMING ARTS SCHOLARSHIP RECOMMENDATION FORM
Applicant, please provide a copy of this form to the person(s) providing a letter of recommendation for you.
Applicant’s Name:
Last Name
First Name
Middle Initial
TO THE REFERENCE:
The student named above is applying to the Mary Doctor Performing Arts Scholarship Fund.
The Mary Doctor Performing Arts Scholarship Fund benefits graduating high school seniors within the Charlotte Region who
demonstrate above-average ability and great interest in one or more areas of the performing arts. The scholarship recognizes students
with financial need who 1) demonstrate ability and great interest in one or more areas of the performing arts; 2) plan to pursue an
undergraduate major in a discipline strongly related to the performing arts; and 3) demonstrate the desire to use their training to enrich
the lives of others.
The scholarship is administered by the Education Department of Blumenthal Performing Arts in conjunction with Foundation For The
Carolinas.
Neither The Doctor Family Foundation nor Blumenthal Performing Arts discriminate on the basis of disability, age, race, color, religion,
gender or any other classification protected by Federal and/or North Carolina state constitutional and/or statutory laws. All scholarships
are awarded in accordance with Foundation For The Carolinas policies.
Please return this form and your single-sided typewritten recommendation to the applicant (in a sealed envelope with your
signature across the flap) so that he or she may submit it as part of a total application package. The Scholarship Committee
will not review incomplete applications. The application deadline is March 27, 2015.
Your Name:
Title:
Indicate your relationship to the applicant:
How long have you known the applicant?
Mailing Street Address:
City, State, ZIP:
Daytime Phone:
Email:
Signature:
2014-2015 Application
Date: