Scholarship Application Form

 
ATTRUS C. FLEMING MUSIC SCHOLARSHIP FUND

 
Application For
Academic School Year 2007-2008 Scholarship
(Jazz Brass Instruments, Woodwind Instruments, and Guitar Only)
 

 LAST NAME ____________________________________________  FIRST NAME ______________________________   MIDDLE NAME  ______________________

 SUFFIX  ____________  (Jr., Sr., III, etc.)       

 HOME ADDRESS  ______________________________________________________________________________________________________________________

 CITY  ______________________________________________________________________   STATE ______________________   ZIP CODE  ___________________

 PHONE 1 [with area code]  (_______)  ___________ -__________________    PHONE 2 [with area code]    (________)  ___________ -___________________

 NAME OF PARENT or GUARDIAN  ________________________________________________________________________________________________________

 DATE OF BIRTH  ______ /______ /__________  (mm/dd/yyyy)               AGE  _________                          _____  MALE  or  _____  FEMALE

 # YEARS OF MUSIC STUDY  ______________          NAME OF CURRENT MUSIC TEACHER  __________________________________________________________   

 ANTICIPATED HIGH SCHOOL GRADUATION DATE  _________________________  (month & year)

 NAME OF HIGH SCHOOL   ______________________________________________________________________________________________________________

 HIGH SCHOOL STREET ADDRESS  __________________________________________________________________________________________________________

 HIGH SCHOOL CITY ______________________________________________   HIGH SCHOOL STATE ____________   HIGH SCHOOL ZIP CODE  ________________

 HIGH SCHOOL PHONE [with area code]    (_________)  ___________ -___________________

 EXPECTED COLLEGE/UNIVERSITY  (if known)   ______________________________________________   CITY _________________________   STATE  __________

 EXPECTED MAJOR ____________________________________________   EXPECTED MINOR (if applicable)  __________________________________________

HOW DID YOU BECOME AWARE OF THE FLEMING MUSIC SCHOLARSHIP? ______________________________________________________________________

For eligibility requirements and application procedures, please click on the “Eligibility Requirements” link on this website.

For scholarship consideration, please mail the following materials along with the completed application to: THE ATTRUS C. FLEMING MUSIC SCHOLARSHIP FUND, PO Box 40006, Washington, DC  20016-0006:
     1)   A photograph (which will not be returned).
     2)   A CD or audio tape recording of performance, including two contrasting pieces which should not exceed a
            total of 15 minutes.  CDs and tapes will not be returned.
     3)   A letter of recommendation from a music teacher (including telephone number).
     4)   A character reference from a non-family member (including telephone number).

DO NOT WRITE BELOW THIS LINE – FOR OFFICIAL USE ONLY

 Date Postmarked  ______________________       Date Received  _____________________       Received By  ______________________________________

 Received:    ____ Application       _____ Photo         ____ CD or Tape Recording          ____  Letter of Recommendation           ____ Character Reference

Music endures forever …