Dear Friend of the Actors Gymnasium

Scholarship Application 2017-2018

At The Actors Gymnasium, people learn to fly physically, emotionally and creatively. We achieve this by offering classes, event entertainment and fully staged productions.

In order to help keep The Gym as accessible as possible, we offer a limited number of need-based scholarships for most classes. Scholarships are made possible by the support of generous individuals and the ability to provide scholarship assistance is subject to the availability of funds. We feel strongly that scholarships are not a handout but rather a helping hand. In times of need, financial assistance is granted as part of a partnership – each participant will pay part of the tuition based on both a sliding scale, and the specific needs of each applicant.

Any student may apply. Need is determined by 1) reviewing the student’s financial situation including household size, and 2) the letters submitted with their application. Applicants may receive one scholarship per student per session, with a maximum of two scholarships per family, per session (valid towards one class only per student). Scholarship applicants need not be Evanston residents to apply.

Everyone is welcome atThe Actors Gym. We believe that diversity is a fundamental strength and our mission is best achieved when we embrace diversity as both a core value and a daily practice.

The Actors Gym does not discriminate on the basis of race, creed, color, sex, age, national origin, disability, sexual orientation, gender identity, marital or veteran status. We reserve the right to exercise discretion in accepting students and assume no special liability for scholarship students. Students may be denied entrance if, in the professional judgment of the faculty and administration, their participation would pose a danger to themselves or to others.

We have made every effort to keep the initial submission requirements manageable. You may, however, be asked to provide other documentation to help us review your application. All information will be held confidential. If you need assistance in completing this application, please contact the Gym office.

We award scholarships of up to 95 percent of course tuition. In general, in order to qualify for a scholarship, your annual gross household income must be below a certain level (see the matrix at the top of the application form), but we welcome scholarship applications from families above this income level as well. Be sure to describe your circumstances in the required Financial Needs Letter.

NEW & ANNUAL RENEWAL APPLICANTS RETURNING APPLICANTS

PLEASE SUBMIT ONCE PER SCHOOL YEAR: PLEASE SUBMIT EACH SESSION:

☐Application Form☐Application Form

☐copy of IRS1040 Form☐Financial Needs Letter (see details below)

☐copies of 2 Most Recent Paystubs☐Student Letter (see details below)

(or proof of current public assistance)(Income verification is required once per academic year)

☐Financial Needs Letter – please explain the

cause or need for the scholarship.

If parents live separately, please be certain to

describe the custodial arrangement and sources of financial support for the student.

☐Student Letter – please address the following questions:

1. Why do you want to study at The Actors Gymnasium?
2. What other class(es) have you taken at The Gym?
3. If you have received assistance in the past, what impact did that have?
4. What are your goals from taking the requested class?

☐Waiver of Liability

Please be as specific as possible when requesting your class so that we can hold a spot in the class while your application is being reviewed. Please allow two weeks for processing your application.

* Partial scholarships are available for households with incomes above this level.

Student Name(s) - Please Print Legibly

1. ______

FIRSTLASTDATE OF BIRTH

______

GRADE SCHOOL / COLLEGEAG CLASS REQUESTED COURSE TUITION

WHAT DO YOU THINK THAT YOU CAN AFFORD?______

1. ______

FIRSTLASTDATE OF BIRTH

______

GRADE SCHOOL / COLLEGEAG CLASS REQUESTED COURSE TUITION

WHAT DO YOU THINK THAT YOU CAN AFFORD?______

Parents/Guardians For Students Under 18

______

FIRST LAST RELATIONSHIP

______

FIRST LAST RELATIONSHIP

Primary ContactEmail ______

StreetAddress______City______State ____ Zip ______

Phone 1 ( ) ______Work/Cell/Home Phone 2 ( ) ______Work/Cell/Home

Secondary Contact Email ______

StreetAddress______City______State ____ Zip ______

Phone 1 ( ) ______Work/Cell/Home Phone 2 ( ) ______Work/Cell/Home

Number of People in Primary Household ______

Signature of Student Or Parent/Guardian ______Date: ______