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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