SCHOLARSHIP APPLICATION

Scholarship Applicant Information

First Name *

Last Name *

Email *

Phone *

Address 1 *

City *

State/Province *

Zip *

My pronouns are:

They/Them
She/Her
He/Him

---Other pronouns:

I am requesting a scholarship for: *

Myself
Another person

What is your relationship to attendee?: *

Self
Parent/Guardian
Other

Class & Attendee Information

Class/Program Name: *

Class/Program Date: *

Class Attendee Full Name (or SELF)

Attendee Age & Grade: (if under 18)

Attendee Pronouns:

They/Them
She/Her
He/Him

---Other pronouns:

Is there anything else you would like us to know about the attendee?

Scholarship Information

We place a high priority on keeping the Art Base accessible and will give your request full and serious consideration. Please keep in mind that the Art Base is a small nonprofit and only ask for what you truly need.

For this class registration I am requesting: *

a full scholarship
a partial scholarship

If a full scholarship is not available I will accept a partial scholarship:

Yes
No
Depends on the amount available

If a partial scholarship is available for this class, I am able to pay the following toward the cost of the class:

Is there anything else you would like us to know about your scholarship application?

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SCHOLARSHIP APPLICATION

Scholarship Applicant Information

Class & Attendee Information

Scholarship Information