South Haven Center for the Arts
Class Scholarship Request

Funds may be requested from the Class Scholarship fund to cover tuition and fees for South Haven Center for the Arts classes only. It is not designed as a general tuition grant fund. Classes are subject to cancellation if the minimum number of students do not sign-up.

Requests must be returned to the Center ten days prior to the beginning of the first class.

A scholarship is requested for:

1. Student's Name:_______________________________ 2. Birthday: ___________

3. Parent/guardian name: ___________________________________

4. Address: _____________________________________________

5. Phone: ______________________________________________

6. For what class are you requesting a scholarship? ______________________________

7. What is the cost of the class? ______________________

8. How did you learn about this scholarship program? ____________________________

________________________________________________________________________

________________________________________________________________________

9. Teacher's/sponsors name: ________________________________________

10. What school does the student attend? ________________________________

11. Is the student eligible for Free Hot lunch? Yes / No

12. I would like to request a scholarship to cover the tuition for the above named class for my child/ward, named above. I understand that the scholarship will cover only the class related expenses and that the Center, which manages this program, will not give refunds to students if they withdraw or cease to attend the class.

____________________________________________
signature of parent/guardian date

This scholarship is made possible through a generous grant from
the Youth Activities Committee of the Greater South Haven Area Foundation Fund
and the Winter Lights Committee.