Eastern Music Camp Scholarship Application

To apply for a $100.00 general scholarship to attend the 2015 Eastern Music Camp, please complete this application.

2015 Music Camp Scholarship Application deadline is April 24, 2015.

Questions or Concerns please contact Danelle Larson, Co-Director of Eastern Music Camp at dlarson@eiu.edu

Student Name Student Name * First Last
Gender *

Gender Male Female
Street Address Street Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone Phone * - ### - ### ####
Camp Attending *
Indicate Instrument or Vocal Part *

For example trumpet, soprano, violin, alto sax etc.
How many years have you attended Eastern Music Camp? *
Please list the specific years attended and which camp you attended *

For example... 2014- Choir Camp
Name of School *
Grade in Fall 2015 *
Name of Music Director *
Why do you want to attend Eastern Music Camp? *
List musical achievements, awards, and activities: *
Student Signature *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY
Parent/Guardian Name Parent/Guardian Name First Last
Parent/Guardian Signature *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY