APPLICATION FORM SHARON PICOT AND CHIP PICOT STUDENT SCHOLARSHIP

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This application form must be completed in full and returned with the required attachments on or before April 20, 2023. Email to suffolkartleague.education@gmail.com,

Name *

Age *

Address *

City *

State *

zip code *

Parent/Guardian name: *

Parent or Guardian Address (if different from applicant)

Phone Number: *

Email address: *

School now attending: *

Grade Level 2023-2024 *

Scholastic Achievement
*

Good=A/B

Average=B/C

Poor=C, D, F

List courses studied in artistic area of choice:
*

General statement of family finances and of financial need.
*

What will the scholarship be used for? Be specific: Include description and estimated cost per item with a total amount requested. (i.e. lessons from whom & cost, purchase/rent of instrument from where & cost, materials, etc.)
*

Total Scholarship Amount Requested:
*

Future plans in the artistic area of choice:
*

Student Signature:
*

Parent/Guardian Signature: *

Application Check List: Please email additional items to suffolkartleague.education@gmail.com *

Obtain and attach a letter of recommendation from a teacher, guidance counselor or other mentor. This recommendation can not be from an immediate family member.

Compose and attach an essay of between 100-300 words stating the applicant’s interest and their goals and intentions for how they will use the scholarship funds. This essay MUST be written by the applicant.

Completing this Application

Required

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