LTW Danny Burgess Scholarship Application

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Scholarship will be awarded for one year, but the recipient may re-apply the following year. Applicant must supply their most current GPA as of the end of the 1st semester marking period. The Scholarship Committee reserves the right to withhold a scholarship during any given year. Deadline of application is May 17, 2024.

Name *

Age *

Phone Number *

Email address *

Address *

Are you a resident of Jefferson or Lewis counties in NY? *

Yes, Jefferson

Yes, Lewis

Parent(s)/Guardian(s) or Spouse name(s) and Occupation(s) *

Please write N/A if not applicable.

Number of Members in family *

Please write N/A if not applicable.

Are you a high school senior accepted for full-time enrollment or a full-time college student currently enrolled in a recognized college or university? *

Yes, a high school senior accepted for full-time enrollment

Yes, a full-time college student currently enrolled in a recognized college or university

Name of institution/college/university that applicant attends or is planning to attend. *

Are you majoring in a performance art (music, acting, directing, arts education, dance or theatre tech)? *

Yes

It is my minor

It is an extracurricular activity

What is your major/proposed course of study? *

Have you been actively involved in community theater in Jefferson or Lewis County, New York? (Little Theatre of Watertown, Watertown Lyric Theater, Carthage Little Theatre, Stage Notes, Butler Did It Players, high school or college productions)? *

Yes

What is your theater background and experience? *

Please include all acting, technical and other volunteer/theatrical opportunities that you have been involved in.

What additional hobbies and activities do you have that are pertinent to the performing arts? *

Please submit TWO references (name/phone/email) from an appropriate teacher, instructor or mentor. *

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