Scholarship/Honorarium Application Form

This page is to be filled out by the workshop participant and submitted on-line or printed and mailed. The reference for application form is to be filled out by a person giving references for the participant.

Scholarship Application

Applicant Info
Previous Instruction
Workshop Selection
Add'l Information

Applicant Information

First Name

Last Name

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Are you presently attending school?

Yes

Name of School

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Are you under the age of 18?

Yes

Name of Parent

Parent's Email

Parent's Phone

Parent's Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Previous Instruction at Dillman's

Year

Instructor Name

Workshop Selections

First Choice

Instructor Name

Date

Second Choice

Instructor Name

Date

Third Choice

Instructor Name

Date

First Preferred Artistic Medium:

Second Preferred Artistic Medium:

How many years have you been participating in your first preferred medium?

What minimum dollar value do you require to take advantage of the workshop?

Additional Information

List any notable achievements or awards:

List any creative groups of which you are presently a member of: (i.e. art leagues, photo club, writers group, etc.)

FOR SCHOLARSHIPS - Please use the box below to make a brief statement describing your reasons for applying for the award. List the factors that would affect your ability to pay tuition. Explain how a workshop would benefit your future plans. HONORARIUMS do not require proof of financial need.

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