P. O. BOX 4194 ! SALISBURY, MARYLAND 21803-4194
410.546.1068 ! [email protected] ! www.ccartfoundation.org
STUDENT PERSONAL INFORMATION FORM
PLEASE REFER TO CCART SCHOLARSHIP REQUIREMENTS & GUIDELINES WHEN COMPLETING THIS
FORM. ADDITIONAL SHEETS MAY BE NECESSARY.
STUDENT’S NAME
SOCIAL SECURITY #
ADDRESS
PHONE #
E-MAIL
PARENT’S NAME(S)
PARENT’S ADDRESS
HIGH SCHOOL/COUNTY/STATE
CLASS STANDING
STUDENTS IN THE CLASS.
OF
TOTAL NUMBER OF
GRADE POINT AVERAGE
PRIMARY ART TEACHER, SCHOOL/VISUAL ARTS INSTRUCTION, PHONE #, E-MAIL ADDRESS
AWARDS & HONORS
ART COURSES COMPLETED (HIGH SCHOOL, PRIVATE, OTHER)
SCHOOL (EXTRA CURRICULAR ACTIVITIES IN WHICH YOU ARE INVOLVED (BOTH ART & NON-ART
RELATED)
COLLEGES/UNIVERSITIES/VISUAL ART PROGRAMS TO WHICH YOU HAVE APPLIED
COLLEGES/UNIVERSITIES/VISUAL ART PROGRAMS TO WHICH YOU HAVE BEEN ACCEPTED WITH
THEIR ADDRESSES LISTED IN ORDER OF YOUR PREFERENCE.
INTENDED COURSE OF STUDY IN THE VISUAL ARTS
Page 1 of 4
P. O. BOX 4194 ! SALISBURY, MARYLAND 21803-4194
410.546.1068 ! [email protected] ! www.ccartfoundation.org
STATEMENT TO CCART DESCRIBING YOUR BACKGROUND AND REASONS FOR PURSUING THESE
SCHOLARSHIPS. USE SEPARATE SHEET IF NECESSARY.
SIGNATURE OF STUDENT
DATE
RELEASE FORM
PLEASE SIGN THIS FORM WHICH PERMITS THE CAVALLARO CLEARY VISUAL ARTS FOUNDATION
(CCART) TO PHOTOGRAPH AND/OR VIDEO STUDENT APPLICANTS AND ARTWORK FOR PROMOTIONAL,
EDUCATIONAL AND ARCHIVAL PURPOSES.
_________________________________________________
STUDENT (PRINT)
_________________________________________________ _________________________________
STUDENT SIGNATURE
DATE
IF STUDENT IS UNDER 18 YEARS OF AGE:
_________________________________________________
PARENT OR GUARDIAN (PRINT)
_________________________________________________ __________________________________
PARENT OR GUARDIAN SIGNATURE
DATE
Page 2 of 4
P. O. BOX 4194 ! SALISBURY, MARYLAND 21803-4194
410.546.1068 ! [email protected] ! www.ccartfoundation.org
RECOMMENDATION FOR CCART SCHOLARSHIP (1 OF 2 REQUIRED).
ART TEACHERS OR OTHERS PROVIDING RECOMMENDATION, PLEASE PRINT OR TYPE RESPONSES. IF
FURTHER SPACE IS NEEDED FOR COMPLETION, PLEASE USE THE BACK OF THIS FORM. DEADLINE
FRIDAY, APRIL 3, 2015, BY 5:00 P.M. THANK YOU.
YOUR NAME:
STUDENT’S NAME:
YOUR RELATIONSHIP TO THE STUDENT:
STUDENT STRENGTHS:
WEAKNESSES:
RECOMMENDATION:
SIGNATURE:
TITLE/POSITION/PROFESSION:
ADDRESS/PHONE/EMAIL ADDRESS:
DATE:
PLEASE SEND RECOMMENDATION LETTERS SIGNED AND SEALED WITH APPLICATION PACKET OR MAIL
SEPARATELY TO: CCART SCHOLARSHIP BOARD, P. O. BOX 4194, SALISBURY, MD 21803-4194.
Page 3 of 4
P. O. BOX 4194 ! SALISBURY, MARYLAND 21803-4194
410.546.1068 ! [email protected] ! www.ccartfoundation.org
RECOMMENDATION FOR CCART SCHOLARSHIP (2 OF 2 REQUIRED).
ART TEACHERS OR OTHERS PROVIDING RECOMMENDATION, PLEASE PRINT OR TYPE RESPONSES. IF
FURTHER SPACE IS NEEDED FOR COMPLETION, PLEASE USE THE BACK OF THIS FORM. DEADLINE
FRIDAY, APRIL 3, 2015, BY 5:00 P.M. THANK YOU.
YOUR NAME:
STUDENT’S NAME:
YOUR RELATIONSHIP TO THE STUDENT:
STUDENT STRENGTHS:
WEAKNESSES:
RECOMMENDATION:
SIGNATURE:
TITLE/POSITION/PROFESSION:
ADDRESS/PHONE/EMAIL ADDRESS:
DATE:
PLEASE SEND RECOMMENDATION LETTERS SIGNED AND SEALED WITH APPLICATION PACKET OR MAIL
SEPARATELY TO: CCART SCHOLARSHIP BOARD, P. O. BOX 4194, SALISBURY, MD 21803-4194.
Page 4 of 4