Playhouse Institute Conservatory Financial Assistance Application

Playhouse Institute Conservatory Financial Assistance Application
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Phone Number
Email
example@example.com
Last Year Completed in School
To be Completed by Student
If I receive financial assistance and I agree to send a thank you letter to my sponsor before the end of the experience. I agree to follow all guidelines and policies set by the Center while I attend the Playhouse Institute Conservatory.
Please tell us why you'd like to be a part of the Playhouse Institute Conservatory.
To be Completed by Student
Have you been a part of any BCP Education programing including Student Theater Festival, Youth Company, public classes etc
How did you hear about the Playhouse Institute Conservatory?
Child's Signature

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To be Completed by Parent / Guardian
Please write a brief statement describing how financial aid would help your child participate in the program.
To be Completed by Parent / Guardian
What is your occupation / job title?
Do you have a partner or spouse? If so what is their occupation?
Number of dependents

What is your total household income: Check the appropriate box.

	Under $40,000	$40,000-$50,000	$50,000-$60,000	$60,000 and Up
Income

How much assistance are you requesting for this program?

25% ($350)50% ($700)75% ($1050)100% ($1400)
The amount of assistance is based off a rolling tier.

The items listed below are to be transferred from your 1040: (Includes spouse's information is applicable).
List Special Circumstances (If Any)
By signing this document, I agree that the information is accurate.
Parent / Guardian Name

First NameLast Name
Parent / Guardian Signature

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References

Please feel free to enclude any additional references endorsing your child's participation in this program. References should be sent to BCPedu@buckscountyplayhouse.org
Recommendation Letter:

Cancelof
Thank you for applying for financial assistance. Assistance will be given based on the availability of funds and level of need.

This application is confidential. The information on the form will not be disseminated.

The deadline for financial aid is one week before the program's start date. Once all applications have been reviewed, you will be notified.
Should be Empty:

To be Completed by Student