School Tour in Gallery

Scholarship Application Form


Please be sure to read the Scholarship Brochure before completing the online application.

Contact us for more information about participating in this program at Scholarships@nelson-atkins.org.

Scholarship Application Form

Be sure to fill out the scholarship application completely. Incomplete applications will not be processed. Please include emergency contact information for the student.






 
Student Name Birth Date(mm/dd/yyyy)
School Student's Age
 
 
Sponsor Details
A sponsor is someone who thinks the student would benefit from participation in classes and has awareness of the family’s financial status. A sponsor may be a teacher, counselor, religious leader, youth worker, community professional or social worker. A family member may not sponsor a student. Note: The sponsor is not responsible for any fees or costs associated with the programs. They will be contacted to confirm the student’s eligibility to the program, please ensure their details are correct.
 
Name  
 
Organization  
 
Address  
 
City State Zip
Phone  
 
Sponsor Email  
 
Confirm Sponsor Email  
 
Relationship to the student  
 
 
Family Details
 
Parent/Guardian Name
 
Address  
 
City State Zip
Home Phone  
 
Work Phone/Cell Phone  
 
Parent Email  
 
Confirm Parent Email  
 
 
Please fill in completely
 
Number of adults in the household
Number of children under 18 years in the household  
 
 
If you receive any of the following forms of assistance please indicate which you receive (click all that apply):  
WIC School Lunch Program Medicaid and Medicare SSI Food Stamps
 
Total Annual Household Income:
Under $10,000
$10,000-$11,999
$12,000-$14,999
$15,000-$19,999
$20,000-$24,999
$25,000-$30,000
     If over $30,000, indicate amount of income
$
 
Please indicate any special financial circumstances that influence your family’s financial situation:
 
Emergency Contact Information:
Name Phone Number
 
Optional Question:
What is this person’s race? Mark one or more races to indicate what this person considers himself/herself to be.
American Indian or Alaska Native
Asian
Black or African American
Hispanic
Native Hawaiian or Pacific Islander
White
Other
 
Studio Session Request
Select an age appropriate class. Make a first and second choice.
View complete list of children’s studio classes.


Fall
Winter
Spring
Summer
 
First choice, include day and time of session
 
Second choice, include day and time of session
 

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