Aboriginal Arts Scholarship Application Form

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2012 ABORIGINAL ARTS STUDIO FOR TEENS SCHOLARSHIP APPLICATION FOR ABORIGINAL STUDENTS DEADLINE:

Friday February 24, 2012 at 4:00 pm

RETURN TO:

2012 Aboriginal Arts Studio Applications Continuing Studies, Emily Carr University of Art + Design 1399 Johnston Street, Vancouver, BC V6H 3R9 Email: teens@ecuad.ca

Fax: 604 630 4535

STUDENT DETAILS Student Name: ________________________________________________________________________________ Date of Birth: _____________________________________ Age on July 1, 2012: __ _____________________ School:

___________________________________________________________________________________

Grade Completed by June 30, 2012: ___________________________________________________________ Please list any art classes you have taken: _____________________________________________________ ________________________________________________________________________________________________ Home Address: _______________________________________________________________________________ _________________________________________________________________________________________________ City:

_______________________________________

Postal Code:

__________________________

Email:

___________________________________________________________________________________

Phone:

___________________________________________________________________________________

Name of Parent/Guardian: ______________________________________________________________________ Email:

___________________________________________________________________________________

Phone:

___________________________________________________________________________________

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