WALLY MOON SCHOLARSHIP FOR SUMMER STUDY IN THE ARTS

Please return this form, including a sealed letter of recommendation, to

The Arts Association of East Alabama by May 13, 2013.
Applicants Name:

Birth Date:

Address, City, State, Zip:

Parents Names:
Address (if different):
Home Telephone Number:
Family Income:

___Under $25,000

___ $25,000-$50,000

___ $50,000-$75,000

___Over $75,000

School: ____________________________________________________________________________
Grade Point Average: (if available) ______________ Verification Signature: ____________________
Arts Background (experience, honors, awards, etc.) _________________________________________
__________________________________________________________________________________
_____________________________________________________ (Use back if more space is needed)
Have you been awarded this Youth Arts Scholarship in any previous summer? If so, when? _________
Camp/Seminar Applied to: ____________________________________________________________
Address, City, State, Zip: _____________________________________________________________
Telephone Number: _______________________________ Dates Attending: ____________________
Fees: ___________________________________________ Expected Date of Acceptance: _________
Program Emphasis: __________________________________________________________________
Are you receiving any other assistance to participate in this program? Explain ____________________
__________________________________________________________________________________
__________________________________
Parent/Guardian Signature
Send application and a sealed recommendation letter to:
Summer Scholarship Committee
The Arts Association of East Alabama
1032 South Railroad Avenue
Opelika, AL 36801

Call 334.749.8105 or email:

scholarships@eastalabamaarts.org
for further information.