University City Arts League
Summer Camp
SCHOLARSHIP APPLICATION
You must complete all parts of the application in
order to be considered. Scholarships are limited and awarded on a first-come
first-serve need basis.
Application is
due by _________________
Please mail or drop off this application to:
Attn: Jeanene Johnson
UCAL
4226 Spruce Street
Philadelphia, PA 19139
OR fax to: 215-382-3339, Attn: Jeanene Johnson
Student
Information
Student name ______________________________________________
Age ______________
Program session & class applying for
________________________________________________________
Student name ______________________________________________
Age ______________
Program session & class applying for
________________________________________________________
Student name ______________________________________________
Age ______________
Program session & class applying for
________________________________________________________
Parent/Guardian
Information
Parent/Guardian name(s) ______________________________________________________________
Permanent address
___________________________________________________________________
City_________________________________________ State
_____________ ZIP _________________
Phone # ___________________________ Email
___________________________________________
Marital Status (circle one): Single Partnered/Married Divorced Widowed
Number of dependents excluding yourself ________________
Are you currently employed? __________________________
*Please list
ALL current employers and list employment/income of both parents/guardians if
partnered/married
Name of current employer
________________________________________________________
Position ________________________ Monthly salary ___________________________
Name of current employer ________________________________________________________
Position ________________________ Monthly salary
___________________________
Other monthly income (child
support, government aid, social security, etc.)
Total monthly expenses
___________________________________________
What amount per week can you contribute for your
child’s program? __________________________
**Don’t forget
to submit supporting documentation of your household income (paystub, etc.)
with this application