Geoff Richter Performing Arts Award Application

Applicant Information

A) Personal

Applicant’s Name*

First Last

Permanent Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Date of Birth*

Mobile Phone*

Email Address*

B) Family

Parent's Name

First Last

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Email

Occupation

Parent's Name

First Last

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Occupation

C) Education

Current Enrollment Status for Upcoming Year*

Full-time student
Part-time student

Name Of College You Will Be Attending In The Upcoming Academic Year*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Expected Graduation Date*

Degree/Major Sought*

Grade Point Average Last Semester*

Please enter a number from 0 to 5.

If you have not yet attended, please enter 0

Cumulative Grade Point Average*

Please enter a number from 0 to 5.

If you have not yet attended, please enter 0

Academic Honors Received

Future Educational Goals

Previous Undergraduate College (if applicable)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dates Attended (start)

Dates Attended (finish)

Degree/Major Received

Previous Undergraduate School

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dates Attended (start)

Dates Attended (end)

Degree Received

Academic Honors Received

High School*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dates Attended (start)*

Dates Attended (end)*

Other School

D) Employment History

Employment Status*

Current Employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Employer(s)

Company	Address	Start Date	End Date	Supervisor	Position Held

E) Extracurricular Activities and Affiliations

Performance History

Extracurricular and/or Volunteer Activities

Honors and/or Awards

G) Personal Statement

Provide a brief personal statement of your academic interests including your short and long term goals. Please write anonymously with no references to personally identifiable information. If additional space is necessary, please submit your personal statement as separate document.*

Uploads (submitted as PDF or JPG)

Official Educational Institution Transcript

File*

Drop files here or

Accepted file types: pdf, jpg, Max. file size: 50 MB.

Applicant Ackowledgement*

I hereby acknowledge that I will download the form and request a letter of recommendation.
I hereby acknowledge that I will be submitting a sample of a performance.

Applicant Consent*

I hereby certify that the information provided in this application is true and correct.

Applicant's Signature*

Date*

Fill out the application below.

Applicant Information

A) Personal

B) Family

C) Education

D) Employment History

E) Extracurricular Activities and Affiliations

G) Personal Statement

Uploads (submitted as PDF or JPG)

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