Date: _________________________
I.  General Information

1.	Participant’s Name_________________________________________       Birthdate ____________

2. 	Address_________________________________ City___________________ Zip______________

3.	Name of parents or guardians _______________________________________________________

4.	Address, if different from participant __________________________________________________

5.	Parental marital status:		Single:  ______	Married:  _____	Widowed:  _____

6.	Home phone:  ______________________________	Work/daytime phone: __________________
II.  The Program

7.	Name of the Program ______________________________________________________________

8.	Dates of the Program ______________________________________________________________
III.  Financial Data

9.	Describe the costs of this program.

10.	Please state the dollar amount of the grant you are requesting to help meet the expenses of the 

program:  _________________________.

Financial aid forms must be filled out completely.  An income statement may be required for anyone requesting more than one-quarter of the tuition amount.

Deadline:  December 31