SCHOLARSHIPS

GoggleWorks transforms lives through unique interactions with art regardless of financial means. To this end, we offer two types of scholarships year-round on a rolling basis. Scholarships are limited to one class or camp per child.

Section A / Student Information

Name of Student

Age of Student

Ethnicity (optional)

Address

City/State Zipcode

Phone Email

Have you previously taken a class / workshop at GoggleWorks Center for the Arts

If applicant is under 18, please provide the following

Name of Parent/Guardian Current School

Current Grade

Section B / Course Selection

Para Aplicaci N En Espa Ol

Indicate the class/workshops you are interested in below. Please note that scholarship seats are offered on a first-come, first-served basis and depend on the current enrollment in class/workshop specified. Age restrictions are noted per class. Any exceptions must be pre-approved by the Programs Department.

First Choice Start Date

Second Choice Start Date

Third Choice Start Date

Note: Scholarship covers tuition only. Applicant (or parent/guardian) is responsible for any material fees associated with the class/workshop of their choice. GoggleWorks does not discriminate based on race, creed, color, religion, sex, national origin, ancestry, age, sexual preference or ability, nor on the basis of an individual’s physical or mental disability.

Section C / Financial Documentation

The following information is required to determine eligibility for scholarship acceptance. All information will be kept confidential. Please attach a complete copy of your most recent Form 1040 income tax return. Number of individuals (adults and children) supported by this income.

AND if applicant is under 18, please provide one of the following : - copy of the student free and reduced lunch program ID card - copy of student’s Medicaid card

The information supplied is true and accurate to the best of my knowledge. I understand that any false information will result in cancellation of this application and any scholarship granted.

Please return this form to GoggleWorks or visit goggleworks.org/programs/scholarships/ to fill out an online application.