The Dennis Buege Memorial Scholarship Fund

APPLICANT PERSONAL INFORMATION

Name*

FirstLast

Address*

Street AddressCityStateZIP Code

Phone*

Cell Phone

Applicant Email if applicable

SSN#

Age*

Date of Birth*

Current School if Applicable

Current Grade if Applicable

How did you hear of Dimensions Dance Center and the Scholarship Program?*

Parent Information - if applicant is under the age of 18

Mother's Name*

FirstLast

Father's Name*

FirstLast

Address*

Street AddressCityStateZIP Code

Phone*

Employment Information

Applicant's Employer if over 18 OR Mother's Employer if applicant is under 18 years of age.

Length of Employment

Employer's Phone

Annual Salary (before tax)*

Father's Current Employer

Length of Employment

Employer's Phone

Annual Salary (before tax)

Please list any additional income from alternative sources

Please send or deliver a copy of your most recent Federal Tax Return as well as two recent paycheck stubs to Sandra Morgan at Dimensions Dance Center.

1201 North Warson Road St. Louis, MO 63132-1805

Dance History

Please list all dance classes and locations attended.

Example: Ballet 1 / Studio A / 2004

Please list the names, locations and dates of any dance performances

Example: Dancing in the Streets / STL / 2010

What are your dance goals?*

What do you want to learn? What do you want to accomplish?

Special Circumstances

Please list any special circumstances that you feel are important and/or affect your financial status

Scholarship Request

Select the classes you want to take*

Are you currently a member of any dance company at Dimensions Dance Center:*

If not currently a member are you planning to audition?

(Membership in a dance company is NOT required to receive scholarship funds)

Estimated Monthly Tuition Costs*

Your Estimated Monthly Contribution*

Amount of Scholarship Request (monthly)*

WAIVER

The applicant is hereby informed that all funds distributed by Dimensions Dance Center (DDC) Scholarship Program are done so at the sole discretion of DDC and that the determination of said distribution shall not be influenced by age, race, or creed. However, distribution is determined by the applicant’s dance audition and financial need. To qualify for funds, recipients are required to agree to a scholarship contract which ensures the responsibility of the recipient and the use of the funds for the purpose for which they are intended.

I declare that the information in this application is true and correct.*

Yes
No

To submit this application you must be 18 or the Parent or Legal Guardian of the Applicant. Which one are you?*

I am 18
I am the applicant's parent
I am the applicant's legal guardian

Phone

This field is for validation purposes and should be left unchanged.