Scholarship Application

Scholarship Application

Fill out the application below for the opportunity to have 50-100% of the registration fee for any Children's Program at Blue Line Arts.
Student Information
Student Name*

First NameLast Name
Student Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth:*

MonthDayYear
Date
Name of School:*
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian E-mail*
example@example.com
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number*

Area CodePhone Number
Are you a student?
High School:
Date of Graduation:
How did you hear about this scholarship?
Number of Adults in the household:
Number of Children (under 18) in the household:
If you receive any of the following forms of assistance, please indicate which you receive (check all that apply)

WICSchool Lunch ProgramMedicaid/MedicareSSIFood Stamps
Total Household Income:

Under $10,000$10,000-$14,999$15,000-$19,999$20,000-$24,999$25,000-$29,999$30,000-$34,999$35,000-$39,999Over $40,000
Please Indicate any special financial circumstances that influence your family's financial situation.
Program Information:
Visit http://www.bluelinearts.org/category/childrens-programs for our current program listing or call (916) 783-4117 for more information. Please list top three choices of programs below.
Name of Program (first choice):
Start Date:

MonthDayYear
Date
Name of program (second choice):
Start Date:

MonthDayYear
Date
Name of Program (third choice):
Start Date:

MonthDayYear
Date
Supplemental Questions
1. Does the student have an interest in the visual arts? Please explain.
2. Does the student have the transportation and support needed to attend every class session?
The student must include one of the following in order to be considered for a scholarship:
- A letter of interest from the student (50 word minimum)
- A letter of support from the family (100 word minimum)
- A letter of recommendation from the family (100 word minimum)
- A photograph example of the students drawing or painting no larger than 9" x 12"
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Scholarship Application

Student Information

Parent/Guardian Information

Program Information: