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LITTLE TOWN PLAYERS, INC. SCHOLARSHIP APPLICATION FORM Name: Address: City: State: Zip: Home Phone: Email Address: ________________________________________________________________________ School Now Attending: SAT/ACT Scores: Language GPA: Math Total Institution of Higher Learning that you plan to attend (Attach copy of acceptance letter): Do you hold a part-time job? Yes No If yes, where do you work, what are your duties, and how many hours weekly do you work? (You may use a separate sheet of paper) What is your parent’s yearly income? Under $35,000 $55,001-$75,000 $35,000-$55,000 $75,001 and up How many younger siblings are living at home with you now? How many siblings are in college at this time? On a separate sheet, please share any extraordinary circumstances (such as medical expenses, family situations, etc.) or other circumstances you would like us to know. On a separate sheet of paper, please elaborate on the following: A. Describe any performing or visual arts experiences that you have had in either high school or community productions. Be sure to specify your participation with Little Town Players. B. List any other extra curricular or community activities in which you have participated. C. List any honors or awards that you have received. D. What are your future plans? E. Explain what role you feel that the theatre plays in the life of a community. SIGNATURE: DATE: Rev. Jan 2004