Simple and Needs-Based

First Name (required)

Middle Name

Last Name (required)

Street (required)

City (required)

State (required)

Zip (required)

Street

City

State

Zip

Primary Phone

Alt./Cell Phone

Email Address (required)

Alt. Email Address (if applicable)

Gender
 Male Female

Date of Birth (if under the age of 18):

(Primay Contact)

Name

Relation

Primary Phone

Alt. Phone

(2nd Contact (if applicable))

Name

Relation

Primary Phone

Alt. Phone

Age/Grade
/

Name of parent/guardian:

Number of adults in household

Ages of children in household

Father's occupation and employer

Mother's occupation and employer

Your occupation and employer

What class(es) are you requesting this scholarship for this semester?

(Remember: if you are applying for a SIMPLE scholarship, there is a *Maximum of two scholarship requests for dance classes or one request for non-dance classes per semester (maximum of up to 50% off of each class). If you are applying for a needs-based scholarship, there is a maximum of up to 100% for 1 dance class or camp per semester – or two regular arts classes per year)

Listed tuition price for class(es)

In addition to the class(*es) you are applying for a scholarship for, what other classes will/would you be/are you enrolling in with Weehawken this semester?

Amount of scholarship money requested

Have you applied for aid from WCA before?
 Yes No

Have you received aid from WCA before?
 Yes No

Why are you interested in taking this class/these classes?

Why do you feel deserving of this award?

Please describe your financial need for this scholarship.

How do you plan to utilize what you hope to learn through this scholarship?

Is there anything else you would like to tell us?

In some instances, and depending on the number of applications, Weehawken may not be able to grant all of the scholarship requests that come forward 100%. On the same note, Weehawken is sometimes willing to trade labor or services for classes. Is there any special skill that we should be aware of that you are willing to offer? Or, is there a limit to the amount of time that you might be able to contribute in trade for a class?

Please provide us with the names and contact information of at least two people who can speak to your need.

Contact #1

Name:
Phone:
Relationship to applicant:

Contact #2

Name:
Phone:
Relationship to applicant:

I have read and understand Weehawken’s scholarship information and policies. I understand that if awarded a scholarship, I am expected to complete at least 8 hours of volunteer service per class scholarship to Weehawken during this semester. Failure to complete volunteer hours will result in expulsion from the scholarship program in the future. And, I hereby certify that all of the above information is correct.

Typing your name in the following form constitutes an electronic signature

Signature of applicant or guardian

Date