Financial Assistance Application
Qualifying Factors
*
ACHA Section 8 Housing
Social Security / Disability (Parent/Guardian)
WIC Program
SNAP
Medicaid/Medicare/Soonercare
Foster Care
None of the above
Other factors worth consideration
Please list any other factors or extenuating circumstances that you feel might qualify you for a scholarship. (Extenuating circumstances may include: Recent job layoffs, family hardships, medical conditions, etc.)
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Student Information
Student Name
*
First Name
Last Name
Parent / Guardian Name
*
First Name
Last Name
Student's Age
Student's School
Grade in School
Please enter a value between 1 and 12.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent / Guardian Email
*
example@example.com
Parent / Guardian Phone
*
Please enter a valid phone number.
How do you describe yourself?
American Indian or Alaska Native
Hawaiian or Other Pacific Islander
Asian or Asian American
Black or African American
Hispanic or Latino
Non-Hispanic White
I choose not to answer
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References
In certain situations, Theatre Tulsa may feel the need to verify information with official persons close to the applicant and their family. Please provide at least one reference who would feel comfortable verifying any of the information listed above. This person can be a minister school counselor, teacher, etc.
Reference #1 Name
First Name
Last Name
Relationship to Applicant
Phone Number
Please enter a valid phone number.
Email
example@example.com
Reference #2 Name
First Name
Last Name
Relationship to applicant
Phone Number
Please enter a valid phone number.
Email
example@example.com
Submit
Should be Empty: