Sam and Rose Licata Scholarship Form

List the number of years you have participated in the following

	Band	Orchestra	Choir
Number of years

Your siblings and their ages
How many of your siblings are in college or private school?
What are your reasons for requesting a scholarship?
List all of your musical study experiences and accomplishments
Thinking back over your years in high school, list your extracurricular activities (musical and otherwise)
Thinking back over your years in high school, list your community service projects:

Thinking back over your years in high school, list any clubs or organizations in which you hold/held membership:
In relation to your chosen major degree in college, what are your career objectives and ambitions?
Have you participated in the IMA contest in the past? If so, in what respect?
If you have participated in the IMA contest, what suggestions can you offer, to improve upon any aspect of the contest:
What suggestions do you have for the IMA to raise money for our scholarship fund?
What/who inspired you to choose music as your major/minor field of study? (Describe in 400 words or less)

The Illinois Music Association (IMA) reserve the right to use the photograph and name of the scholarship winners in fundraising projects and published print advertisements. Your signature on this application acknowledges the Illinois Music Associations intention to do so and gives your consent for your name and photograph to be used.
Applicant Signature

Powered by Jotform Sign Clear
Parent Signature

Powered by Jotform Sign Clear
**Please check to make sure that all of the information in this application is complete and accurate.

**Incomplete application forms will not be accepted.

**Someone from the IMA Scholarship committee will be in touch, regarding a date and time for your interview and performance. [Please be aware that this might be a virtual interview and performance (be prepared with the proper equipment and placement of such, so that you can be seen and heard). Check the IMA website for details.]
Should be Empty:

Sam and Rose Licata Scholarship Application