SAGINAW BAY YOUTH ORCHESTRA—Tuition Assistance Request
For Office Use
Date Rcd:
Send completed form to:
SBSO Scholarship Committee, 201 N. Washington Ave., Saginaw MI 48607
Tuition Assistance is available for students whose families demonstrate qualified need.
Only complete applications are considered.
All financial and personal information is kept strictly confidential.
Dep pd:
Min practiced/#wk:
Stdt#1
Stdt#2
Stdt#3
Name of Student #1 ___________________________________________ Date of birth ___________________Grade ___________
Race/Ethnicity African American Asian
Caucasian
Hispanic Native American Other
Name of Student #2 ___________________________________________ Date of birth ___________________Grade ___________
Race/Ethnicity African American Asian
Caucasian
Hispanic Native American Other
Name of Student #3 ___________________________________________ Date of birth ___________________Grade ___________
Race/Ethnicity African American Asian
Caucasian
Hispanic Native American Other
Current School: Student #1 _____________________ Student #2 ______________________ Student #3 ______________________
Home address _______________________________________________________________________________________________
City ____________________________ Zip ___________________ Parent Cell Phone _____________________________________
PART A
Does your child qualify for the Federal free or reduced lunch program at school?
Yes Reduced lunch
No
Free lunch
Which school district? ______________________________________
PART B
Instrument(s) ___________________________________ How long has student played this instrument? _______________________
Does the student study privately on this instrument?
YES
NO
If yes, with whom? ______________________________________________ Teacher’s phone _______________________
Does the student participate in his/her school/church music ensembles?
YES
NO
If yes, where? ________________________________________________________________________________________
If no, why? __________________________________________________________________________________________
PART C
Name of primary parent/guardian ____________________________________________Cell phone ___________________________
Occupation of primary parent/guardian ____________________________________ Email __________________________________
Place of employment/title _____________________________________________________________ Full-time Part-time
Name of secondary parent/guardian __________________________________________Cell phone ___________________________
Occupation of secondary parent/guardian __________________________________ Email __________________________________
Place of employment/title ______________________________________________________________ Full-time Part-time
PART D
CONFIDENTIAL FINANCIAL INFORMATION
PLEASE NOTE: Because limited scholarship funds are available, financial need is a major factor to be considered in the awarding of
most scholarships. In order to make SAGINAW BAY YOUTH ORCHESTRA accessible to all, please give serious
consideration to how much assistance is needed.
Household size:
Please indicate the total number of persons living within you household who are dependent on your income: _________
List ages of all children living at home, including applicant: __________________________________________
List other dependents: ________________________________________________________________________
How much financial assistance are you hoping to receive with this application? _________________
Are there other possible family sources of financial assistance? (For example, a parent who may not live with the child
full-time, grandparents, etc.)
YES. How much assistance? ________________
NO
Please discuss in the space below any other personal financial issues or special circumstances which you feel the
Scholarship Committee should consider in making the awards. NOTE: This section MUST be completed. (Use
additional page, if necessary.)
SBSO reserves the right to request additional family financial information, if necessary.
PART D—Read carefully.
We certify that all of the information in this application is true and correct. In accepting financial assistance from the
SBSO, we agree that the scholarship recipient will attend ALL rehearsals, concerts, and fundraisers during the each
session enrolled in the 2015-2016 SBYO Season.
We also understand that we may be required to help with set-up and teardown for rehearsal. We understand that if these
obligations are not fulfilled, we may be asked to repay scholarship funds which have been awarded.
Parent/Guardian signature ____________________________________________ Date ________________
Student signature ___________________________________________________ Date ________________
11/2015