Scholarship Application

Adult Participant or Parent Name
 
Address:
  
City:
  
State:
  
Zip:
  
Day Phone:
  
Evening Phone:
  
Email Address:
  
     

Student Information

    
Student Name
 
Age
  
School
  
Grade
  
     
Student Name
  
Age
  
School
  
Grade
 

 

Annual income (for children, give income of parent/guardian(s) with whom the child is living). Please include all sources of income, i.e. salary, tips, child support, alimony, ADC, etc. Attach proof of financial status such as a pay check stub, welfare check stub, copy of tax return, etc. Application will not be considered if missing this information.

    

Head of Household #1

  
Place of Employment
  
Annual income $
  

   
Head of Household #2
  
Place of Employment
  
Annual income$
  
   
How many persons are supported by this income?
  
     
Please give their names, ages and relationship to you. 
 
   
Are there special circumstances, financial or otherwise, that we should consider in assessing this application?
   

Has you family received a Dayton Art Institute Scholarship before? If yes what class?

  
     

What class are you interested in receiving a scholarship for?

  
     
If not awarded a scholarship, do you still wish to register for the class and pay the required fees?
 

   

How did you learn about this class

  
   
Signature (parent/guardian signature if application is for a child)


Date

 

 

Signature

   

This form must be completed in full and proof of financial status must be attached for your application to be considered.

Please print out and return this application along with the completed class registration form two weeks prior to the start of the session you are interested in. Mail to:

The Dayton Art Institute
Education Department
456 Belmonte Park North
Dayton, OH 45405-4700

The Dayton Art Institute recognizes that some families do not have the financial resources for extracurricular activities. In keeping with our mission to serve a diverse audience by providing them with exposure to the arts through a variety of learning experiences, The Dayton Art Institute has set forth scholarship guidelines.

Families requesting a scholarship must submit a scholarship application form along with proof of financial status. Scholarship applications will be evaluated by the Educator for Museum Programs and will be held in strict confidence. Size of the scholarship will be determined on a case by case basis. In addition to scholarships, families may be permitted to submit fees according to a payment plan set up between the individual and the Educator for Museum Programs. All fees must be paid prior to the start of the class.

Families are eligible for multiple scholarships in a given year. However, subsequent scholarships will not exceed 25% of the class fees.

 
     
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