________________
Office use only
Student Identification Data Page
George Souten Performing Arts Scholarship
FOUR COUNTY COMMUNITY FOUNDATION, 231 E. ST. CLAIR ST. PO BOX 539, ALMONT, MI 48003
810-798-0909
www.4ccf.org
program@4ccf.org
Name Click here to enter text.
High School Click here to enter text.
Year Graduating Click here to enter text.
College Major: (Must be in the performing arts) Click here to enter text.
Parent/Guardian
Click here to enter text.
Home Address
Click here to enter text.
Click here to enter text. Zip Click here to enter text.
Telephone Click here to enter text.
Email (print clearly)
Click here to enter text.
Items to Submit – 11 Total Copies:
1.) Two (2) Stapled Sets of the following items:
a. Student Identification Page
(Page 1)
b. Student Signature Page
(Page 2)
c. Application Page
(Page 3)
d. Essay
e. High School Transcript
(1 original & 1 copy)
2.) Nine (9) Stapled Sets of the following items:
a. Application Page
b. Essay
(Page 3)
Mail to:
Four County Community Foundation,
231 E. St Clair St.
P.O. Box 539
Almont, MI 48003
Deadline: April 1
GSouten 1/15
Page 1 of 3
________________
Office use only
Signature Page
George Souten Performing Arts Scholarship
FOUR COUNTY COMMUNITY FOUNDATION, 231 E. ST. CLAIR ST. PO BOX 539, ALMONT, MI 48003
810-798-0909
www.4ccf.org
program@4ccf.org
Signature:
My signature below verifies that I am a current senior who will be graduating from Imlay
City Area Schools & I completed this application personally.
________________________________________
Signature
____________________________________
Parent/Guardian Signature
________________________________________
Print or type name
GSouten 1/15
Page 2 of 3
__________________
Office use only
Application Page
George Souten Performing Arts Scholarship
FOUR COUNTY COMMUNITY FOUNDATION, 231 E. ST. CLAIR ST. PO BOX 539, ALMONT, MI 48003
810-798-0909
www.4ccf.org
program@4ccf.org
Eligibility
George Souten Performing Arts Scholarships are open to high school seniors who attend and/or
reside in one of the four school districts served by Four County Community Foundation, which
are: Armada, Capac, Imlay City or Romeo. This scholarship is for performing arts majors only.
All applications must be received at the Four County Community Foundation by April 1.
Applications will be anonymously reviewed by the foundation’s Youth Advisory Committee and
approved by Trustees of the Four County Community Foundation.
DO NOT put your NAME on this application page or on the back essay page.
Age Click here to enter text.
Grade Click here to enter text.
College Click here to enter text.
text.
Estimated Cost per year Click here to enter
Program Start Date Click here to enter text.
Major / Must be in Performing Arts: Click here to enter text.
1.) List your current activities that involve your performing arts areas of interest:
2.) Essay
Write a 3 to 4 paragraph essay describing your college plans in the performing arts and
your career plans for the future. Attach Essay. DO NOT include your name
GSouten 1/15
Page 3 of 3