Kirkland Arts Center
Scholarship Application
SCHOLARSHIP INFORMATION
We are pleased to provide you an opportunity to apply for KAC’s Scholarship Programs. Participation
gives you access to one free class or workshop a quarter. Applicants must apply at least one month (we
are flexible on this) prior to the quarter start date of their desired class in order to be considered for
scholarship. Upon receipt we will contact you for a phone interview. We will then let you know as soon
as possible if the application is approved.
Please type or print neatly in ink. Use additional sheets of paper if necessary. Mail completed application
to 620 Market St, Kirkland, WA 98033; attention Education Director, or email to
sbeggs@kirklandartscenter.org.
APPLICANT INFORMATION
NAME OF APPLICANT__________________________________________________________________________
IF UNDER 18: NAME OF PARENT OR GUARDIAN___________________________________________________
AGE (IF UNDER 18) _______
NAME OF SCHOOL (IF UNDER 18) ______________________________________________________________
APPLICANT’S ADDRESS _____________________________________________
EMAIL ____________________________________________
CITY ______________________________________ STATE _________ ZIP __________________-
DAY TELEPHONE ___________________________________ EVENING PHONE _________________________
Class for which aid is requested (in order of preference):
1)
_________________________________________________________________________
2)
______________________________________________________________________________________
3)
______________________________________________________________________________________
What mediums of art are you interested in (in order of preference)?
1)
______________________________________________________________________________________
2)
______________________________________________________________________________________
3)
______________________________________________________________________________________
YES
Have you ever taken classes at the Kirkland Arts Center?
NO
If yes, when and what classes? __________________________________________________________________
_____________________________________________________________________________________________
1
Kirkland Arts Center
Scholarship Application
How will you benefit from taking classes at the Kirkland Arts Center?
_____________________________________________________________________________________________
INCOME INFORMATION
1)
What is the total annual family income?___________________________(If for youth, please include the income
of both parents, if living together. Please be sure to include all sources of income such as child support, income
from other members of the household, etc.)
2) Please attach one or more of the following documents:
- A copy of the first page of your latest income tax return (1040 form) indicating total annual income.
- Any documentation from federal, state, county or local assistance program that verifies family need.
3) How many adults and children are supported by the income indicated? _____________________
4) Please list any other sources of income (such as child support) and how much is received annually:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Please briefly explain your financial situation
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
REFERENCE INFORMATION
Please list up to three references.
NAME
FIRST
LAST
ADDRESS
CITY
PHONE
EMAIL
RELATIONSHIP
2
STATE
ZIP
Kirkland Arts Center
Scholarship Application
NAME
FIRST
LAST
ADDRESS
CITY
STATE
ZIP
PHONE
EMAIL
RELATIONSHIP
NAME
FIRST
LAST
ADDRESS
CITY
STATE
ZIP
PHONE
EMAIL
RELATIONSHIP
TERMS AND CONDITIONS
Receipt of a scholarship from the Kirkland Arts Center is limited to one per year. Applicants are chosen based upon
financial need. Although exhaustive financial records are not required, a failure to provide accurate information will be
cause for revocation of all scholarship privileges. Scholarship monies must be used in the same quarter and for the
class which they are granted. KAC usually awards partial scholarships and all scholarship recipients are required to
contribute at least $20 to each class. Receipt of a scholarship does not guarantee placement in a specified class,
and prospective students must register in accordance with registration guidelines. The Kirkland Arts Center reserves
the right to cancel any class or workshop, in which case a scholarship recipient may apply funds to a class in the
following quarter. In the event of unreasonable conduct, KAC reserves the unconditional right to terminate a
student’s enrollment without a refund or reinstatement of scholarship monies.
I have read and understood the terms of the scholarship application and agree to these conditions. The information I
have provided is accurate and complete to the best of my knowledge.
SIGNATURE ____________________________________________________________________________
DATE _______________________________ QUARTER APPLIED FOR ______________________________
OFFICE USE ONLY
DATE ____________ QUARTER ____________ APPROVED ___________ AITLISTED __________ DECLINED
___________
COMMENTS_____________________________________________________________________________________________
_
3