2023 Scholarship Application: NYSSSA : OCE : NYSED

2023 Scholarship Application Form

Student Information

First Name :
Last Name:
If different from your legal name, what name do you go by?
Age:
Date of Birth: (mm/dd/yyyy)
Gender:
Student's Cell Phone:	( ) -
Student's E-mail:
Address 1:
Address 2:
City:
State:
Zip Code:
County:
Current Grade:
Do you know what arts program(s) you are applying to? If yes, what program(s)?
Is the arts program you are applying to scheduled to be in-person, virtual or hybrid?

Parent/Guardian's Information

First Name:
Last Name:
Home Phone:	( ) -
Cell Phone:	( ) -
E-mail:
	Check this box if Student Address and Parent Address are the same.
Address 1:
Address 2:
City:
State:
Zip Code:

I, the parent/guardian of the above named student, consent to the release of the information on this application to the Empire State Summer Arts Scholarship Program. I authorize the Empire State Summer Arts Scholarship Program to use my student's name in association with any news releases, and permit the use of any photographs, digital images or videos taken during the audition for publicity or documentation purposes.

School Information

School Name:
Principal's Name:
School Phone:	( ) -
School Address:
City:
State:
Zip Code:
School Contact:
School Contact Phone:	( ) -
School Contact E-mail:

I request mailed copies of Empire State Summer Arts Scholarship Program correspondence
Upon completion of the application form, the student and their parent/guardian will receive an email communication from the Empire State Summer Arts Scholarship Program Office. This email communication will contain instructions on how to submit financial information and detailed information regarding the arts program you are applying to/attending.
(Please note: All student scholarship correspondence will be emailed to both student and parent at addresses provided above.)

Cultural Education

New York State Archives, Library, Museum and Public Broadcasting

2023 Scholarship Application Form