MUST BE POSTMARKED NO LATER THAN MAY 1
Mail to: Scholarship Award, P.O. Box 502, Fultonville, NY 12072

Student Information:

Full Name ___________________________________________  r  Male    r  Female

Home Address _________________________________________________________________

Home Phone ________________________  Birth date ___/___/_______

Parent Information:

Father's Name ____________________________________ r  Living r  Deceased

Mother's Name ___________________________________ r  Living r  Deceased

Number of Brothers & Sisters under 18 years of age:  _______

College Information:

Name of school you will attend this fall: _____________________________________________

Location of school ______________________________________________________________

Will you  r  Live on campus r  Live off-campus r  Commute from home

What will your major be? ________________________________________________________

What career path are you considering or planning to follow? ____________________________

What is your personal goal for your first year of college? _______________________________

_____________________________________________________________________________

How do you plan to participate, enhance and/or support the arts in your new college environment or new college town?



What will you tell your new college acquaintances about your high school art experiences?





FOVAPA Experiences:

Have you ever participated in a program sponsored by the Friends of the Visual & Performing Arts (FOVAPA)? r  Yes  r  No  If yes, describe all FOVAPA experiences below (what program, what year, how participated):




Committee Volunteer or Board of Directors Member (what position, what year, what you did)


Festival Volunteer (what year, what you did)


Describe how FOVAPA's program has influenced your art/life.




Other Art Experiences:

Number of years in high school art   ____   Describe your high school art coursework:



Have you ever displayed your artwork in any show outside of high school?   ____ Yes    ____ No
Where/when/what show(s)?


List other art classes/coursework/activities outside of high school in the last four years?


Describe the high school art experience you are most proud of and explain why.



Describe below how you have contributed to the quality, quantity and/or appreciation of art in your school.




Applicant may include one attachment if desired.

Applicant's Signature _____________________________________ Date _____________