Grant Application Form

 

____________________________________________________________________________
Name of Applicant:

 

____________________________________________________________________________
Address:
 

 

City/Province: __________________________________ Postal Code: _________________

 

Telephone: _____________________ Office: _______________________________

 

Email: _______________________________________________________________

 

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

 

 

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.