GIRASOL FOUNDATION Co-payment assistance Application

Girasol Foundation is committed to making arts education available to any student with a desire to learn. The inability to afford tuition should not prevent a student from participating in our acting classes. If you are experiencing financial difficulties, and have interest in our acting classes, please complete the following questions and submit this application with your registration. Scholarship Application Deadline: April 15 2014 Levels of resources Level I Household income less than $ 18,0000 Level II Household income less than $ 26,000 Level III Household income less than $ 40,000 Fees per child - per class 5.00 15.00 20.00

Student Name: __________________________________________________________ Please Choose Program/Class: ACTING PROGRAM ACCESSIBILITY PROGRAM AFTER SCHOOL PROGRAMS SUMMER SCHOOL PROGRAM ________ ________ ________ ________

For the Student: Please write four or five sentences explaining why attending the ACTING/ACCESSIBILITY program is important to you.

For the Parent or Adult Student: Please write one or two sentences about why you are applying for a scholarship.

Taking into consideration the table above, what amount could you afford to pay per class (if any)?

You will receive a letter notifying you of our assistance availability upon receipt of your registration. Thank you for your interest in our programs.