Scholarship Program To apply for the Scholarship Program, please fill out the form below or contact the director at 314-997-7837 Section APPLICANT PERSONAL INFORMATION Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Age Date of Birth MM DD YYYY Current School if applicable Current Grade if applicable Pre-School Kindergarten 1 2 3 4 5 6 7 8 9 10 11 12 College How did you hear of Dimensions Dance Center and the Scholarship Program? Family Facebook Friend Radio Twitter Web Search Other PARENT INFORMATION IF APPLICANT IS UNDER THE AGE OF 18 Mother's Name First Name Last Name Father's Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### EMPLOYMENT INFORMATION Applicant's Current 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. DOCUMENTS MUST BE RECEIVED WITHIN TWO WEEKS OF APPLICATION. 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 Checkbox Ballet Jazz Hip Hop Lyrical Pointe Tap 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 Thank you!
