Art Scholarship Application

Name:____________________________________________

Address:__________________________________________

City:________________________ St.______ Zip:_________

Level of aid applied for: 

Basic : $50.00 ____
(Dues Paid or if applicant is not a current member the award will include dues as a part of an award up to $50.00)

Contributing : $100.00 _____
(Dues Paid plus one of the following in the last two years- donated to raffle, served on a committee, helped promote an event, held a position, served as an officer, is eligible for ½ class fees up to $100.00)

 Sustaining: $200.00_____
(Dues Paid plus two of the above in the last two years is eligible for ½ of class fees up to $200.00)

Class or Workshop title_______________________________________

Cost:_______________

Date :_______________________

Location:___________________________________________________

 Attach copy of class schedule, course description, registration form or other documentation showing this class offering.

________ for AHA's   use_________________________________________________ 

Scholarship amount awarded___________          Verification of Level    ________________

Date awarded ________________      Approved by ________________________ and ________________-____________