Apply for a Scholarship - Symposium

Name

Date of Birth

Address

City/Town

State/Province

ZIP/Postal Code

Home Phone

Cell Phone

Work Phone

Email Address

Tuition/Fee

Please describe your current financial situation

What do you hope to gain by participating?

Scholarship Amount Requested

It has been our experience that those who contribute to the fee feel more invested in the program.

Are you able to contribute toward the fee? (If yes, list amount)

Please tell us more about you! We are committed to creating a diverse and inclusive organization. The following section is optional, but your information will help us greatly in developing future programs and events. Thank you! Your privacy matters to us. Your information will never be shared or sold.

Age

18-25

26-45

46-65

65+

Gender

Female

Male

Non-Binary

Self-Identified:

Protected Classes (Select all that apply)

Veteran or Active Duty Personnel

English Language Learner

Living with a Disability

Living below the Poverty Line

Living in non-traditional housing (such as a hospital, assisted care facility, homeless shelter or other transitional housing facility)

None of the above

Self-Identified:

Race/Ethnicity (Select all that apply)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Prefer not to say

Self-Identified:

Questions? Contact Sarah Jayne Kennelly, BCA Public Programs Assistant at skennelly@burlingtoncityarts.org, or call 802-865-7166