Music Scholarship Application

(at this time we are only accepting applicants from the United States)

General Information
Today's Date:
Full Name:
Address:
City:	State:	Zip:
E-mail Address:
Home Telephone:	Cell Phone:
Date of Birth:
Musical Background
Instrument or Voice
Number of years of study:
Name of teacher recommending:
List Repertoire you have covered to include Technical Studies, Vocalizes, Solo Literature, etc. include Programs of recital performances if you have them.
List the selections that you wish to perform at the audition. (Voice and Band Instrument Applicants must provide their own accompanists. )
Make a brief statement regarding your professional goals in music:
Educational Background
Do you have a high school diploma?	If so, from where?
School Graduation Year	City:	State:
Guidance Counselor:
College(s) attended:	Year(s):
Current GPA:	SAT Score:	ACT Score:
Are you employed now/will you need to work while at Chipola?
Have you applied for any type of Financial Aid?
If so, explain:
Briefly list any previous employment experience:
In what other outside activities or groups do you participate?
List any honors or awards you have received:
In addition to this form, please complete a Chipola Foundation Scholarship Application. I wish to audition on: February 21, 2013 March 14, 2013 April 25, 2013 May 9, 2013

Print a copy of Scholarship Application before submiting and mail or bring completed form to:

Dr. Daniel Powell, Associate Dean
Fine and Performing Arts Department
Chipola College
3094 Indian Circle
Marianna, FL 32446