Grant Application Form

(Please Print)

Name of Applicant: ____________________________________________________________________________

Address: ____________________________________________________________________________________

City/Province: _________________________________________________ Postal Code: __________________

Telephone: _____________________ Office: _______________________________

Email: _______________________________________________________________

Age (if under 18): ____________ Are you employed? __________________

If yes, please indicate where and your position:

1. Briefly outline the program for which you are applying. Please explain what you will be studying, where you attended the program, when, and the length of the program/course.

2. What were the costs of this program/course?

Registration Fee: ______________________ Accommodation Costs: ___________________________

Transportation Cost: ______________________ Other Costs: __________________________________

3. Are you currently attending school or college______________ If yes, please list the name of your school or college, your Grade or your program of study.

____________________________________________________________________________________________

4. Briefly explain your Fine Arts experience or participation below:

4.1 )Medicine Hat Musical Theatre Productions:

4.2) Other musical or theatrical group productions in Medicine Hat:

4.3) Other musical or theatrical group productions outside of Medicine Hat:

4) Other related involvement(s):

5) Have you previously received a grant from Medicine Hat Musical Theatre? _______________ If yes, please explain.

7) Are you applying for funding from another source or organization? ____________ If yes, please indicate the name of the source/organization and the amount you are requesting.

8) Please provide any additional information you feel would support your current application (e.g. financial need, reasons for taking the course, course recommendations, etc.)

9) Please provide the names and telephone numbers of three individuals we may contact in reference to your application and their relationship to you.

1. _______________________________________________________________ Phone: __________________

2. _______________________________________________________________ Phone: __________________

3. _______________________________________________________________ Phone: __________________

Your Signature: ___________________________________________________

Include Parent Signature (if under 18 years of age):____________________________________________

Date: _______________________________

Thank You. Consideration of your application will be given at the first Board meeting following the date of your application.