Scholarship Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Do you receive any of the following?
*
SNAP
Cash Assistance
SSI
Free School Lunches
How many people are in your household?
*
Please Select
1
2
3
4
5
6 or more
Please tell us in the space below why you would benefit from receiving a scholarship and for what do you wish to use it.
Amount Requested
Type a question
I agree that all information I have provided is true and accurate. If I am found to have provided false information, I will be responsible for repaying the Butler Art Center and Gallery any and all monies given to me for my scholarship.
Email
example@example.com
Signature
Should be Empty: