Scholarships - Silvermine Arts Center

Scholarship Application Form

Scholarship applications are being accepted for Summer Camps, ages 3-17.
Please fill out this application in its entirety. Scholarships will be awarded based upon financial need, interest and ability. The number of scholarships and the amounts given are determined by donations made to the Scholarship Fund. For this reason, not every applicant will receive a scholarship award.

If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. Please use proper spelling, capitalization and punctuation. Applications containing out of service phone numbers or invalid email addresses cannot be considered.

Application Deadline – April 14, 2023

I. Parent/Guardian Personal Data

First Name *

Last Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent Date of Birth *//

Phone *

Email *

Demographic Information (Parent)

Information regarding gender, ethnic origin and race are required. The information is requested for post-scholarship grant reporting only and in no way affects your selection for a scholarship award. However, providing this information may increase your opportunities for scholarships where donors have asked that priority consideration be given to students meeting certain demographic criteria (such as minority status, area of study, etc.)

II. Child Scholarship Applicant Information

First Name *

Last Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth (Child) *//

Name of school currently attending: *

Grade Level *

Type of School *

Public
Private

III.Demographic Information (Child)

Please check veteran status (Check all that apply) *

Child of a Veteran
Grandchild of a Veteran
None of the Above

Additional Information

Silvermine Art Center strives to provide an inclusive classroom environment and provide the best possible experience possible for all students. The questions below are include to help teachers and staff better serve your child in the classroom. Please answer them with as much detail as possible.

Does your child receive special services at school? *

If answering “Yes” to the above question, please describe the services:

Does your child require 1-1 support or an aide in the classroom? *

If your child is aged 5 and under do they require assistance using the restroom? *

IV. Financial Information

Please note that if you are awarded a scholarship, you will be asked to provide proof of total household income.

How many people are supported on this income? *

V. Interest in Art (Child)

If under age 14, please have this section filled out by a parent, guardian or teacher, otherwise please fill out in your own words. Limit to 150 words or less.

Tell us about your interest in art? *

Have you taken Art classes outside of school? If so, where and what medium? *

How will a scholarship at Silvermine Arts Center benefit you? *

Have you received an Art Scholarship in the past 2 years? *

Yes - from Silvermine Arts Center
Yes - from Other Organization
No

VI. Camps

Please provide full title and dates of the camps you are interested in. View the summer ecatalog on our website www.silvermineart.org/ecatalog/

CHOICE 1 - Name of Camp (for example - Summer of Art & Drama (Ages: 6-9) *

Date of Camp (for example - Week 6: July 24 – July 28) *

Select Time *

Morning Camp
Afternoon Camp

CHOICE 2 - Name of Camp (for example - Summer of Art & Drama (Ages: 6-9) *

Date of Camp (for example - Week 6: July 24 – July 28) *

Select Time *

Morning Camp
Afternoon Camp

CHOICE 3- Name of Camp (for example - Summer of Art & Drama (Ages: 6-9) *

Date of Camp (for example - Week 6: July 24 – July 28) *

Select Time *

Morning Camp
Afternoon Camp

Applicant's Signature

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person (or parent/guardian) completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.

e-Signature *

Phone

Silvermine Arts Center is committed to equal opportunity in employment and education. Silvermine does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.

The best way to predict the future is to create it

Scholarship Application Form

I. Parent/Guardian Personal Data

Demographic Information (Parent)

II. Child Scholarship Applicant Information

III.Demographic Information (Child)

Additional Information

IV. Financial Information

V. Interest in Art (Child)

VI. Camps

Applicant's Signature

The best way to predict the future
is to create it