MARY DOCTOR PERFORMING ARTS SCHOLARSHIP STUDENT APPLICATION FORM SCHOLARSHIP AWARDS On behalf of The Doctor Family Foundation and Blumenthal Performing Arts, Foundation For The Carolinas ( FFTC ) awards scholarships on the basis of a competitive process that considers performing arts abilities or backstage skills, academic achievement, extracurricular and community involvement, a statement of the applicant s personal aspirations and educational goals, financial need, and references. Scholarships are awarded at the discretion of FFTC s Board of Directors based on The Mary Doctor Performing Arts Scholarship Fund Committee recommendations. FFTC pays scholarship funds directly to the recipient s school. Scholarships are designated for tuition, required fees, books, supplies and school-related living expenses. Scholarships are awarded for one year only. FFTC may consider renewal scholarships for one year each and may be renewed up to three times for a maximum of four years of undergraduate study provided funds are available, the recipient enrolls full-time, and the recipient maintains qualifying criteria. Scholarships are awarded without regard to race, color, ethnicity, national origin, religion, gender or sexual orientation. APPLICATION AND INFORMATION RELEASE STATEMENT The information provided in my application is, to the best of my knowledge, complete and accurate. I understand that false statements on this application may disqualify me from receiving a scholarship. Please submit typewritten responses. PERSONAL INFORMATION (*questions for data collection purposes only) First Name: Last Name: Middle Initial: Date of Birth: Age: Ethnicity: Permanent Street Address: City: County: State: ZIP: Home Telephone: Cellular Telephone: E-mail: Parent/Guardian Name(s) and Address(es) Relationship: High School (HS): Weighted cumulative GPA/scale: Un-weighted cumulative GPA/scale: Name the college or university that you would most like to attend: List colleges or universities that have accepted you for fall 2017 enrollment: List colleges or universities to which you have applied but have not received an acceptance notice: Desired degree and intended major: COLLEGE FINANCIAL INFORMATION (information below must match information from 2017-2018 Student Aid Report (SAR) Estimated Expenses $ Financial Assistance $ 2017-2018 SAR INFORMATION Tuition/Fees: $ Federal/State Grants: $ # in household Room/Board: $ Scholarships: $ # in college including you Books and Supplies: $ Work Study Program: $ Transportation: $ Loans: $ AGI ( Adjusted Gross Income) $ Misc. Personal Expenses: $ Other $ EFC Score (from SAR) TOTAL Expenses: $ TOTAL Assistance: $ Do not change formatting.
Briefly describe below your training and experience to date in the area of performing arts (more detail may be included in your essay if you think appropriate): List the extracurricular activities in which you have participated during your high school years including community service. Please indicate any leadership roles or responsibilities: The Mary Doctor Performing Arts Scholarship Fund provides scholarships to high school seniors who demonstrate financial need as well as ability and great interest in the performing arts. Please briefly describe how a scholarship award would financially impact your ability to attend an institute of higher learning? I verify that all information provided above is accurate Applicant s signature Date Your responses should not exceed this page. Do not change formatting.
Essay Consider carefully the following: Why I Am the Right Choice for the Mary Doctor Performing Arts Scholarship Fund Write an essay (two pages or less) in which you develop your position on this topic. Page 1
Essay Why I Am the Right Choice for The Mary Doctor Performing Arts Scholarship Fund Page 2
MARY DOCTOR PERFORMING ARTS SCHOLARSHIP RECOMMENDATION FORM Applicant, please provide a copy of this form to the person(s) providing a letter of recommendation for you. TO THE REFERENCE: The student named above is applying to the Mary Doctor Performing Arts Scholarship Fund. The Mary Doctor Performing Arts Scholarship Fund benefits graduating high school seniors within the Greater Charlotte Area who 1) demonstrate financial need, 2) demonstrate ability and great interest in one or more areas of the performing arts, 3) plan to pursue an undergraduate degree (major or minor) in a discipline strongly related to the performing arts and 4) demonstrate desire to use their training to enrich the lives of others. The scholarship is administered by the Education Department of Blumenthal Performing Arts in conjunction with Foundation For The Carolinas. Neither The Doctor Family Foundation nor Blumenthal Performing Arts discriminate on the basis of disability, age, race, color, religion, gender or any other classification protected by Federal and/or North Carolina state constitutional and/or statutory laws. All scholarships are awarded in accordance with Foundation For The Carolinas policies. Please return this form and your single-sided typewritten recommendation to the applicant (in a sealed envelope with your signature across the flap) so that he or she may submit it as part of a total application package. The Scholarship Committee will not review incomplete applications. The application deadline is March 24, 2017. Your Name: Title: Indicate your relationship to the applicant: How long have you known the applicant? Mailing Street Address: City, State, ZIP: Daytime Phone: Email: Signature: Date: