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 music 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 music/life.




Other Music Experiences:

Number of years in high school  ___  Band ___  Chorus ___  Drama Club Musicals
Describe participation in music in your high school years. Include both in-school experiences and out-of-school activities. (What bands, ensembles, All-County, NYSSMA, church, other?)






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




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



Applicant may include one attachment if desired.

Applicant's Signature _____________________________________ Date _____________