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Application2008-2009 Name:
_______________________________________________________________________________ LAST FIRST MIDDLE Permanent
Address:
____________________________________________________________________
STREET
CITY
STATE ZIP Telephone: __________________ Email:
___________________ Birth
Date: _________________ EDUCATION: High School
attending or have attended:______________________________________________ City, State:
_____________________________________________________________________ Date Graduated or anticipated to Graduate: ___________________ What is your major course
of study, or intended study? (Be
specific. Example: Vocal music education, trumpet performance, etc.)
_______________________________________________________________ If
your major course of study is music therapy, please answer the following on a
separate sheet of paper: What steps have you taken to understand this
career? What steps have you taken in
proficiency in voice, guitar, and piano? What
was your cumulative grade point average (GPA) as of the most recent semester
or quarter? ______ (Please enclose an
official high school transcript with your application.) Are you currently a United States Citizen or have
you applied for citizenship?_______________________ REFERENCES: Send three letters of
recommendation including at least one who has been your school music
instructor or private music teacher – use the enclosed format for references. Name: _____________________________________ Phone:
________________________ Relationship: _________________________ Name: _____________________________________ Phone:
________________________ Relationship: _________________________ Name: _____________________________________ Phone:
________________________ Relationship: _________________________ FINANCIAL INFORMATION
How
do you intend to finance your college education? (please be specific)
[This scholarship covers tuition and mandatory student fees only.]
Are you receiving any other scholarships? Please list: MUSIC EDUCATION AND BACKGROUND (answer on a separate sheet if you need more space) List any lessons, or experiences that you consider to be formal music training. Include dates of participation. Other music activities, such as band, school chorus, church choir, etc. Extracurricular, volunteer and community activities (not necessarily music-related). What are your professional goals? How might this scholarship help you achieve your goals? WORK EXPERIENCE
Company Name: __________________________________ City/State: _____________________ Supervisor’s Name ___________________________ Phone: ________________________ Position Duties: ______________________________________________________________ Dates of Employment: _________________________________________________________ Company Name: __________________________________ City/State: _____________________ Supervisor’s Name ___________________________ Phone: ________________________ Position Duties: ______________________________________________________________ Dates of Employment: _________________________________________________________ If selected for an audition, do you have any time requests for Sat., April 19, 2008 ? _______________ ________________________________________________________________________________ ATTACH AN ADDITIONAL SHEET
IF YOU NEED MORE SPACE FOR ANY OF THE ABOVE. Part of the requirements
of this scholarship, if you are chosen to be a recipient, is to perform for
one worship service or musical event at I HAVE READ THE
ELIGIBILITY REQUIREMENTS FOR THE Groth Music
Scholarship and, if I am granted a scholarship, agree to these requirements. Signed: _______________________________________________ Date: __________________________ |
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