RUTGERS SUMMER ACTING CONSERVATORY for High School Students

SCHOLARSHIP APPLICATION

Summer, 2008

June 29 to July 27

Scholarships are awarded based Financial Need and Talent.
These funds are made available through the generous support of
the Geraldine R. Dodge Foundation.

All Scholarship submissions must include:

• Completed application
• 2007 Federal Tax Form
• Scholarship Statement

Application deadline: May 15, 2008.

All materials must be postmarked no later than May 15, 2008.

Please print clearly

Student's Name ______________________________________________________________

Mother's Occupation (if applicable)__________________________________________

Work Address ________________________________________________________________

             ________________________________________________________________

Mother work email ___________________________________________________________

Mother’s annual salary $___________________

List any extenuating circumstances concerning the mother’s employment. 

      ___________________________________________________________________________

      ___________________________________________________________________________

      ___________________________________________________________________________

      ___________________________________________________________________________

      ___________________________________________________________________________

Father’s Occupation (if applicable)_________________________________________

Work Address _______________________________________________________________

             _______________________________________________________________

Father’s work email ______________________________________________________

Father’s annual salary $___________________

List any extenuating circumstances concerning the father’s employment. 

      ___________________________________________________________________________

      ___________________________________________________________________________

      ___________________________________________________________________________

      ___________________________________________________________________________

      ___________________________________________________________________________

Father’s annual salary $___________________

List any other monthly income (i.e. child support/alimony, disability, etc.)

Source                                               Amount

_________________________________________________    $__________________

_________________________________________________    $__________________

_________________________________________________    $__________________

_________________________________________________    $__________________

List names and relationship of all individuals living
in the household applying for Scholarship Aid:

Name                                       Relationship

_________________________________________  ___________________

_________________________________________  ___________________

_________________________________________  ___________________

_________________________________________  ___________________

_________________________________________  ___________________

_________________________________________  ___________________

_________________________________________  ___________________

_________________________________________  ___________________

Scholarship Statement

Please discuss in detail the reasons why you feel your child is
deserving of a Scholarship (attach separate sheet, if desired)

___________________________________________________________________________
  
___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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I, ___________________________________________, 
who is the (mother / father / legal guardian) of 


___________________________________________, 
a 2008 applicant for the Rutgers Summer Acting Conservatory, 
hereby acknowledge and affirm that all of the information and documentation 
submitted as a part of this application is true and factual.

        _________________________________________________  

        Signature

        _______________________  

        Date