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2024 Scholarship Application Form

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Student Information

First Name:*

Last Name:*

Current Grade:*


Date of Birth:*


Student's Cell Phone:

Student's E-mail:*

Address 1:*

Address 2:



Zip Code:*


How did you hear about the program:

Do you know what arts program(s) you are applying to? If yes, what program(s)?

Is the arts program you are applying to scheduled to be in-person, virtual or hybrid?*

Parent/Guardian's Information

First Name:*

Last Name:*

Primary Phone:*

Alternate Phone:


Please provide the parent/guardian address if different from the student.

Address 1:

Address 2:



Zip Code:

I, the parent/guardian of the above named student, consent to the release of the information on this application to NYSSSA. I authorize NYSSSA to use my student's name in association with any news releases, and permit the use of any photographs, digital images or videos taken during the audition for publicity or documentation purposes.

School Information

School Name:*

Principal's Name:*

School Phone:*

School Address:*



Zip Code:*

School Contact:*

School Contact Phone:*

School Contact E-mail:*

Upon completion of the application form, the student and their parent/guardian will receive an email communication from the Empire State Summer Arts Scholarship Program Office. This email communication will contain instructions on how to submit financial information and detailed information regarding the arts program you are applying to/attending. (Please note: All student scholarship correspondence will be emailed to both student and parent at addresses provided above.)

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