Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of birth *

MM

DD

YYYY

Parent/Guardian Phone *

(###)

###

####

Level *

High School Grade 9

High School Grade 10

High School Grade 11

High School Grade 12

College Freshman

College Sophomore

College Junior

College Senior

Graduate Masters

Graduate Doctoral

TIER CONSIDERATION *

Tier 1: Solo contribution to the 10:45 a.m. traditional worship service, singing in small ensembles during the worship service, studying music outside of rehearsal, and harboring connections with fellow choir members.

Tier 2: Singing in small ensembles during the 10:45 a.m. traditional worship service, studying music outside of rehearsal, and harboring connections with fellow choir members.

Tier 3: Singing in small ensembles during the 10:45 a.m. traditional worship service and harboring connections with fellow choir members.

Unsure

TERMS & CONDITIONS *

I understand that there are a limited number of scholarships available; acceptance into the program is not given upon submission of the application form. I confirm that I have read the requirements of being a Memorial Presbyterian Church Student Scholar and intend to uphold the standards stated in the “Student Scholar Requirement” form. I understand that I will have to complete an interview and audition for this scholarship. I understand that I am responsible for filling out the Choral Scholarship Expense Report and submitting all receipts for scholarship expenses with receipts attached to the Director of Music and Arts on the first Thursday rehearsal of each month. I understand that in certain situations, scholarship funds are considered taxable income for the recipient. (The Internal Revenue Service provides information about scholarships on their website at www.irs.gov/taxtopics/tc421. For further questions about how this scholarship grant might impact you, consult with your tax professional.) I agree to inform the Director of Music and Arts immediately if my school plans change or have a change in address. Do you agree to the above terms and conditions?

Yes

No