Young People Workshop 2008 Scholarship Form
Scholarships are primarily for full-time Hilltown Residents

Before June 21 send form to: Scholarship Request, BAC, PO Box 286, Becket, MA 01223
After June 25 Bring or send form to the Becket Arts Center.
Circle the Workshop(s) for which you are applying for a scholarship:

Young People: Circus Camp • Dance Together at the Pillow • Puppetry • Improv Theatre
Adult: Workshop _________________________________________

Note: The Visual Arts Workshops are Free.

Please PRINT or TYPE all information:

Last Name __________________ First Name________________ Age (if 14 or under)_____

Address________________________________City______________State____ Zip________

Home Phone ___________________________ E-mail ______________________________

School Name_________________________ (for students age 14 or below)

If the school is not in the Hilltowns, Address of the School ___________________________

(Only If student is under age 14)

Parent/Guardian First Name ______________ Last _______________________________

If different from Student please complete the following:

Address________________________________City______________State____ Zip________

Home Phone _____________________ E-mail _____________________________________

Please attach another paper and write/type150 words or less why the student wants to enroll in the above Workshop program(s).

Since we have a limited amount of funds for scholarships would you be willing to accept a partial scholarship and pay the difference in tuition. See www.becketartscenter.org for fees.
______No ______Yes    I could pay: ____ 10% ____25% ____50% ____75%

How many children under 16 are in the family? _____ Ages ________________

How many adults are in the Family _____ How many working adults are in the Family ______

___$10,000 - $30,000 ___$31,000 - $50,000 ___$51,000 - $75,000 ___$76,000 – $100,000  
___$100,000 – $125,000 __ $126,000 – $150,000 __ Over $150,000

If we asked for income tax records would you be willing to show them to us? ___Yes ___No

Scholarships are supported largely by membership contributions, We are grateful to the people and businesses who have taken ads in this brochure and to The Barrington Foundation Inc, the Puffin Foundation and the local Cultural Councils of Becket, Chester, Hinsdale-Peru, Lee, Washington, and Worthington whose support comes from the Massachusetts Cultural Council, a state agency.