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Scholarship Application
362 N. Martin Luther King Blvd.  |  Lexington, KY  40508  |  859-252-5222 or 255-2284  |  WWW.LASCLEX.org

Parent/Guardian Name:  _________________________________________________________

Student Name:
  _________________________________________________________________

Birthdate of Student:
  _____________________  Male or Female:  _______________________

School (if applicable):
_______________________________   Grade:  ____________________

Address
:  _______________________________________________________________________

City:
  _________________________________  Zip: ____________________________________

Phone (home):
  ___________________________ Work:  ________________________________

Number of people in household
:  ___________  Annual Income:  _______________________

This is a scholarship request for a:

_______________ 50% Scholarship (student pays 50% of the cost of the class)

_______________ 75% Scholarship (student pays 25% of the cost of the class)

_______________100% Full Scholarship (student does not pay for the class) 

Materials and supplies for all classes will be provided by the Living Arts & Science Center. 

Below are the LASC Classes that I am interested in attending.  (If you do not have an LASC class schedule, please call for one or you may look on our Web site for a complete class listing.)

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________ 

I understand that if I receive a partial or full scholarship, I will be able to participate in the class (or classes) of my choice at the Living Arts & Science Center.  I am making a commitment to arrive on time for all of the sessions and to participate fully in the class. 

______________________________________________              _________________
Student Signature                                                                               Date 

As the parent or guardian, I will provide transportation or make arrangements for this student to attend class.

_______________________________________________              _________________
Parent or Guardian Signature                                                             Date 


Scholarships will be awarded based on financial need and availability in the class.   The Living Arts & Science Center will try to meet all scholarship requests.  If we are unable to award a scholarship for the above classes, the LASC will keep your application on file and notify you when there is another available class.

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