This application is solely for application for a scholarship where a student has shown a certain proficiency in the use of photography as an art medium.

Applicant's name (print) _____________________________ Home Telephone ____________
Mailing Address (print) _______________________________________________________
                                    _______________________________________________________
Email address  ______________________________________

Parent/Guardian __________________________________ Home Telephone ____________
Mailing Address: ____________________________________________________________
                         ______________________________________________________

Photography Teacher ____________________ School/Home Telephone _______________

Art Teacher's Mailing Address: _________________________________________
                                                _________________________________________

1. Applicant should complete this form in its entirety and submit five example photographs of their work in photography.

Each photograph should be pasted to an 8 1/2" x 11" piece of paper with the following information on the paper: student artist, teacher for that class, objective of the piece, and signature of your current art teacher confirming that the art work is in fact your creation.

2. Mail this application with the five photos, each on a separate sheet, to the above address for The Shenandoah Fine Art Scholarship.

3. Give the referral to your photography teacher with an addressed envelope. The envelope should also be addressed to The Shenandoah Fine Art Scholarship address listed above. Have her/him complete the form and mail it directly to the scholarship fund in New York.  Except for the teacher referral all parts of the application should be completed by the student.

All completed applications should be in the mail to the New York address listed above.

Should you win the award do you give your permission for your photograph and name to be used on literature for future fund raising? _______ yes _______ no

Signature of applicant ________________________________Year of Graduation__________ Date _________

                                                        ********************************
Page 2.
1.  What is the school you plan to ATTEND and what is the YEARLY COST?  The approximate YEARLY cost of attending a school includes tuition, fees, books, room and board (if necessary) and personal expenses.  If this figure is not known check the College Cost Book in Guidance.

School: _______________________________________ Yearly Cost ______________

On the back, list your back up school(s) and the YEARLY COST.
What is your career choice/or program of study?
__________________________________________

HOUSEHOLD INFORMATION:
1.  What is your parents' current marital status?  _______________
2.  Number of family members. _____ (Include yourself, your parent(s), siblings and others that are supported).
3.  Number of college students in enrolled in the upcoming school year _______ (Include yourself)
FATHER (STEP)
Name ____________________________________________
Address: __________________________________________
_________________________________________________
Occupation: _______________________ Employer: _______________________
MOTHER (STEP)
Name _____________________________________________
Address: ___________________________________________
__________________________________________________
Occupation: _______________________ Employer: _______________________

Have you received a financial aid package from the school you plan to attend?  ( The financial aid package will list what the school is offering you in GRANTS, WORK STUDY, AND LOANS.
______ yes         ______ not at this time

If YES, list the title and amount of  any assistance awarded below.
    GRANTS ____________________  $ ______:   ___________________  $ ______
                     ____________________  $ ______:   ___________________  $ ______
    LOANS   ____________________   $______:   ___________________   $ ______
    WORK STUDY ____________________________ $___________

List on a separate sheet, typed or neatly handwritten, your school, community, and church activities, grades 9-12, including part-time jobs and sports.  If you have held an office in any organization, or received any awards, please include that information.  STAPLE THE SHEET TO THIS FORM.

What art activities have you participated in within the community during high school?
________________________________________________________________

To what civic organizations do your parents (grandparents) belong?  i.e.  Moose, Elks, American Legion, etc. _______________________________________________________
 

************* separate **********

Page 3-7.  This page has to be duplicated fives times, one for each photography.
 
 

You must submit a total of five (5) photos of your work. Each photo is on a separate sheet

                                                       (Paste photograph here.)
 
 
 
 
 
 

List:
1. Student artist: ______________________________________________________________
2. If this work was done in school list the name of the teacher at the time of the assignment? _______________________________________________________________
3. Medium: ___________________________________
4. Objective of the piece: ________________________________________________________
____________________________________________________________________________
_____________________________________________________________________________

6. Signature of your current art teacher who is confirming this work is yours.
Art Teacher: _________________________________ 
 
 
 
 
 
 
 

******** Separate *****************

Page 8.  Detach from the rest of the application and give to the photography teacher with an envelope addressed to the scholarship.

Name of the Warren County High School student who is applying for the Shenandoah Fine Art

Scholarship of New York: (print) ____________________________________________

Name of the art teacher (print) _______________________________ FROM_____WCHS____SKYLINE

This portion of the application has to filled out by the school's photography teacher and mailed by that teacher to the above address for the scholarship. The applicant was instructed to provide the teacher with a stamped and addressed envelope for that purpose.

Please rate 1-5, with 5 being the highest.
Motivation: _____
Talent: _________
Responsibility: ___
Likelihood of completing college _______
How long have you known this student? __________
Can you verify that the photographs of work being submitted are in fact that student's work?
___________________________________________________________________

Other possible comments regarding this student:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Signature of Art Teacher: ___________________________________________
Mailing address: __________________________________________________
                   ______________________________ zip code __________________
Telephone: ____________________________ Email: ______________________