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Effective January 1: Masks are Optional in VisArts’ Classrooms and Studios

Summer Camp Scholarship Application

Student(s) Information
Student Name*
First Last
Date of Birth*
Pronouns*
- He/Him
- She/Her
- They/Them
- Prefer not to say
Grade*
Student Name
First Last
Date of Birth
Pronouns
- He/Him
- She/Her
- They/Them
- Prefer not to say
Grade
Student Name
First Last
Date of Birth
Pronouns
- He/Him
- She/Her
- They/Them
Grade
Parent/Guardian #1 Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Occupation*
Employer*
Work Phone*
Parent/Guardian #2 Information (If applicable)
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*
Occupation
Employer
Work Phone
Dependents
Please list any other dependents and their ages
Application
Total number of dependents*
Adjusted Gross Income - Parent/Guardian #1*
Adjusted Gross Income - Parent/Guardian #2 (If applicable)
Total Combined Adjusted Gross Income*
Your adjusted gross income can be found on the following IRS forms: - 1040 line 37 - 1040 line 47 & 52 - 1040 EZ line 11 - Telefile K (2)
Sessions
Please indicate which sessions you would like to attend, as well as how many students you would like to send to each session.
Young Artist
For students ages 5-6
- Session 1: June 17th - 28th
- Session 2: July 1st - 12th
- Session 3: July 15th - 26th
- Session 4: July 29th - August 9th
- Session 5: August 12th - 23rd
How many students would you like to send to this camp?
Artistic Adventures
For students ages 7-12
- Session 1: June 17th - 28th
- Session 2: July 1st - 12th
- Session 3: July 15th - 26th
- Session 4: July 29th - August 9th
- Session 5: August 12th- 23rd
How many students would you like to send to this camp?
Expiration Date*
Please note that scholarships are issued with an expiration date by which they must be used. Extensions will not be permitted, once the expiration date has passed, if the scholarship has not been used the funds will be allotted to the next applicant.
- I understand and agree with the expiration date policy
Declaration*
- I declare that the above information is true and correct to the best of my knowledge.

Summer Camp Scholarship Application

Summer Camp Scholarship Application

Student(s) Information

Parent/Guardian #1 Information

Parent/Guardian #2 Information (If applicable)

Dependents

Application

Sessions