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APPLICATION FOR THE ARTHUR W. BECKER MEMORAL AWARD APPLICATIONS DUE DEC. 31st, 2016 Name: ______________________________________________________________________________________________________ Address: ____________________________________________________________________________________________________ Phone: _______________________________________E-mail: ________________________________________________________ Are you a current locker holder at Ruby’s Clay Studio?

Yes

No

I am (check one): employed full time as ________________________________ voluntarily not working

unemployed

employed part time as ___________________________________

other __________________________________________________________________

My annual household income last year was:______________________________________________________________________ Arthur Becker was an active member of the Ruby’s community whose family has chosen to honor his dedication to the studio by awarding a subsidy to offset locker fees for community members in financial need. Any locker holder who meets the financial requirements will be considered. The amount and duration of the award to any individual will be based on the extent of that individual’s financial need. An award recipient is required to have at least one piece fired in the community kilns each month and to perform one hour of volunteer work, as provided by the manager, each month. The award will be applied to the recipient’s monthly locker fees for up to six months. A successful applicant is eligible to reapply after 12 months after the award ends. Why you are applying for the award? How will this award affect your work at this stage of your artistic development? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Please describe your participation at the studio (i.e. Are you on a committee or volunteer? How many hours do you spend weekly at the studio? Do you perform any other activities at the studio like firing kilns, attending meetings or performing volunteer credit?). ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ If your personal adjusted gross income for last year exceeded $60,000 or someone else paid more than 50% of your living expenses, please describe your situation and explain why you are applying for the subsidy award. ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ [Please use the back or a second page for your answers if necessary] I certify that the statements I have made above are true and correct. I agree to furnish proof of income upon request. Signed: _______________________________________________________ Dated: ________________________________________ Applications are due DEC. 31st 2016. Please give application to manager or deposit in overnight lock box.


Becker award applciation v7  

The Arthur W. Becker Award awards a subsidy to offset locker fees for community members in financial need.

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