The Art Beat of Rural Ontario
Headwaters Arts Student Scholarship Application
Open for: Visual Arts, Music, Dance and Literature
Award: $1,000.00
Application Deadline: March 15th, 2016, 5:00 pm. (to Headwaters Arts office)
Headwaters Arts Student Scholarship Mandate
The fund has been established to provide financial assistance in the form of a
scholarship to enhance the education and advancement of students of the arts from high
schools in the Headwaters Region. The award will be presented to students in Visual
Arts, Dance, Music, Theatre and Literature during the lifetime of the Fund.
Eligibility Requirements
•
•
•
•
•
The candidate must be a student of the arts.
The candidate must live and attend a secondary school within the Headwaters
Arts region.
The application to request the funds must be submitted within the stated time
frame.
The funds must be used as stated in the application to further the candidate’s
scholastic development in his/her chosen arts accredited program and upon
completion of secondary school
The funds must be used within three years of presentation.
Scholarship Award Application:
Applicants must submit the following information for scholarship consideration.
• A completed application form.
• A letter of recommendation from an academic advisor, academic counselor or
recent instructor.
• A second letter of recommendation from an individual not related to the
candidate.
Please submit the above items in person or in a single envelope mailed to our
office by: March.15, 2016 - 5:00 PM
Headwaters Arts
1402 Queen Street West
Caledon, Ontario L7K 0C3
519 943.1149
www.headwatersarts.com
The Art Beat of Rural Ontario
Contact the office at info@headwatersarts.ca or call 519-943-1149 for more information.
All applicants will be notified by phone and email after the deadline.
(Please Print or Type Clearly)
I. Personal Information
A. Contact information
Name: _______________________________________________________________
E-mail (if applicable): ____________________________________________________
Address: ______________________________________________________________
Phone (H): ___________________________ (C):_____________________________
B. Other Contact: (parent, guardian, etc. or someone who will know how to contact you
if the above information changes)
Name: ________________________________________________________________
E-mail (if applicable)______________________________________________________
Address: _______________________________________________________________
Phone (H): ___________________________ (C):_____________________________
C. Discipline of the Candidate: ___________________________________________
D. Arts Programs completed or enrolled in; formal or informal:
Name: ________________________________________________________________
Name: ________________________________________________________________
Name: ________________________________________________________________
Headwaters Arts
1402 Queen Street West
Caledon, Ontario L7K 0C3
519 943.1149
www.headwatersarts.com
The Art Beat of Rural Ontario
II. Educational Background:
State the name of your current secondary school, the year of study you are presently in,
and any related art programs in which you are enrolled.
III. Future Educational Plans:
State your post-secondary school plans in relation to your discipline.
Proposed course of study/major: ___________________________________________
A. In the space provided or on a separate sheet, describe your post-secondary
and career plans as applicable to your art discipline. (Not to exceed 50 words)
B. In the space provided or on a separate sheet, describe your greatest challenge,
how you faced it and how it has affected you. (Not to exceed 50 words)
Headwaters Arts
1402 Queen Street West
Caledon, Ontario L7K 0C3
519 943.1149
www.headwatersarts.com
The Art Beat of Rural Ontario
IV. Employment and Volunteer History
A. Current Employer: _____________________________________________________
Address: _____________________________________________________________
Supervisor’s Name: _____________________ Phone: ________________________
Dates Worked: From _____________ To _____________ Hours per week ________
B. Other Employment, Volunteer or Relevant Experience
_____________________________________________________________________
Address: _____________________________________________________________
Supervisor’s Name: _____________________ Phone: ________________________
Dates Worked: From _____________ To _____________ Hours per week ________
Other Employment, Volunteer or Relevant Experience
_____________________________________________________________________
Address: _____________________________________________________________
Supervisor’s Name: _____________________ Phone: ________________________
Dates Worked: From _____________ To _____________ Hours per week ________
Other Employment, Volunteer or Relevant Experience
_____________________________________________________________________
Address: _____________________________________________________________
Supervisor’s Name: _____________________ Phone: ________________________
Dates Worked: From _____________ To _____________ Hours per week ________
Headwaters Arts
1402 Queen Street West
Caledon, Ontario L7K 0C3
519 943.1149
www.headwatersarts.com
The Art Beat of Rural Ontario
C. In the space provided or on a separate page, describe how you would use the
Headwaters Arts Student Scholarship to enhance the advancement of your
chosen discipline. Include in your description, a comprehensive action plan
outlining your continuing art education. (Not to exceed 50 words)
I certify that the information provided in this application to be honest and true.
____________________________________________________ _________________
Name (print):
Signature:
Date:
_________________________________________________________ ___________________
Signature of Parent or Guardian if applicant is under 18 years of Age
Date:
Thank you for completing the Headwaters Arts Student Scholarship Application.
Please remember to add letters of reference and copies of examples from your portfolio.
Headwaters Arts
1402 Queen Street West
Caledon, Ontario L7K 0C3
519 943.1149
www.headwatersarts.com