ICE STUDIOS Scholarship Application

Parent Name* This field is required.

First Name

Last Name

Email* This field is required.

example@example.com

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Phone Number* This field is required.A number that can receive text messages

Area Code

Phone Number

STUDENT ETHNICITY ORIGIN (or Race) :* This field is required.Please specify your ethnicity.

White

Hispanic or Latino

Black or African American

Native American or American Indian

Asian/ Pacific Islander

Other

Prefer not to say

EDUCATION (Parent)* This field is required.What is the highest degree of level of school you have completed? If currently enrolled, highest degree received.

No Schooling Completed

High School Graduate, Diploma or the equivalent (GED)

Some High School, No Diploma

Some College Credit

Trade/Technical/Vocational Training

Associate Degree

Bachelor’s Degree

Master’s Degree

Professional Degree

Doctorate Degree

Prefer not to Say

MARITAL STATUS* This field is required.What is your marital status?

Single, never married

Married or domestic partnership

Widowed

Type option 4

Separated

Divorced

Prefer not to Say

AGE (PARENT)* This field is required.What is your age?

18-24

35-44

25-34

45-54

55-64

65-74

75 or older

Prefer not to say

Are you currently…* This field is required.

Employed

Military

Out of work

Unable to work

A homemaker

Self-employed

Out of work but currently looking for work

A Student

Retired

Prefer not to say

Other

What is the age of your child which is participating in our program?* This field is required.If you had more then one child in the program please click all ages that apply

2-3

4-5

6-7

8-9

10-11

12-13

14-15

16-17

Prefer not to say

INCOME STATUS:* This field is required.What is your household income?

$10,000-$20,000

$20,000-$30,000

$30,000-$40,000

$40,000-$50,000

$50,000-$60,000

$60,000-$70,000

$70,000-$80,000

$80,000 or more

Prefer not to say

List all students' names and the number of classes needed for financial assistance for each class.* This field is required.

How much financial assistance is needed?* This field is required.

Registration fee

Recital Ticket

Dancewear

Partial Class fee

Dance Shoes

Costume fee

Dance Workshop fee

What type of support are you seeking?* This field is required.

Why are you requesting financial assistance? (Briefly explain your current financial situation.)* This field is required.

Are you able to contribute any amount toward the workshop?* This field is required.Put No or Yes—Amount you can contribute: $

Tell us how the scholarship will help your child.

ICE STUDIOS Scholarship Application