The Little Theatre on the Square

The Little Theatre On The SquareSullivan Civic Center

P.O. Box 288600 N. Washington

Sullivan, IL61951Sullivan, IL 61951

217-728-2065217-728-4541

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DANCE AND DRAMA TUITION ASSISTANCE FORM

Please review and fill out this form, then submit by mail or drop off the completed form at The Little Theatre On The Square or the SullivanCivicCenter. Applications should be returned by August 27th, 2008. APPLICATIONS WILL NOT BE CONSIDERED IF TURNED IN AFTER THIS DATE. The Scholarship Committee will review applications and contact you by September 8th. Scholarships awarded will be for the full school-year 2008–2009. Family financial responsibility will begin immediately after scholarships are awarded. For Drama classes, the full balance will be due before the first class unless otherwise arranged. Dance Class tuition can be paidin full before the first class, or an adjusted payment plan will be agreed upon, which would also begin before the first class.

BEFORE SUBMITTING APPLICATION PLEASE REVIEW APPLICATION GUIDELINES PAGE.

PART 1 (Parent & Student)

STUDENT NAME: ______D.O.B.: ______

NAME of PARENT(s) / GUARDIAN (If under 18): ______

HOME PHONE #: ______CELL PHONE #: ______

MAILING ADDRESS: ______E-MAIL: ______

Street Address Primary E-Mail

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City, State and Zip Code Secondary/Student E-Mail

TOTAL HOUSEHOLD INCOME 2007: ______2008: ______# in HOUSEHOLD?: _____

FOR WHICH DANCE CLASSES ARE YOU REQUESTING FINANCIAL ASSISTANCE?

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FOR WHICH DRAMA CLASSES ARE YOU REQUESTING FINANCIAL ASSISTANCE?

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Are there any special circumstances that the Scholarship Committee should be aware of upon the review of this application?

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I have verified all above information is correct, and submit this application to the Scholarship Committee for the 2007 to 2008 S.T.A.R. Outreach Program classes.

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Parent Signature Date Student Signature

The Little Theatre On The SquareSullivan Civic Center

P.O. Box 288600 N. Washington

Sullivan, IL61951Sullivan, IL 61951

217-728-2065217-728-4541

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PART 2 (Student: Please Fill Out to Apply for Scholarship)

STUDENT NAME: ______

Please write a brief note to the scholarship committee about why you want to participate in these Dance and/or Drama classes with the S.T.A.R. Program in the space below:

I want to attend Dance and/or Drama Classes because: ______

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PART 3 (Student: Keep A Copy of This Form and Return One Week After Completion of Classes.)

Dear S.T.A.R. Outreach Program Scholarship Committee:

This is what it meant for me to take classes with the S.T.A.R. Outreach Program: ______

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Sincerely,

Name: ______Home Phone #: ______

*Please Note: Registration and Costume Fees are not covered by Tuition Assistance Scholarships*

The Little Theatre On The SquareSullivan Civic Center

P.O. Box 288600 N. Washington

Sullivan, IL61951Sullivan, IL 61951

217-728-2065217-728-4541

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S.T.A.R.

Financial Scholarship Eligibility Guidelines and

Application Procedures

This Scholarship program is offered to accommodate potential S.T.A.R. students who would be unable to participate in our programs due to financial hardships. The S.T.A.R. Scholarship provides reduced fees for those who qualify based upon family income or special family circumstances. As the family works to fill out the application form, please review the following Scholarship Application Eligibility Guidelines:

1.)Due to limited funding qualifying financially for a scholarship does not guarantee

that you will be awarded a scholarship at that amount. Scholarships awards

will be based on income and / or any special considerations, which should benamed

on the scholarship application.

2.)Scholarships will be awarded based upon the demonstrated need, availabilityof

funds and special situation or need consideration.

3.) Amount of fees eligible to be waived will be based on income criteria and household

size and the assessment of Special Situations.

4.) All applicant information is confidential and not a matter of public record.

5.) All applicant information must be true and accurate. Scholarships are legally

recoverable if paid and awarded on the basis of false information.

6.) Proof of financial need must be presented by submitting your most recent Federal I

Income Tax Return (Form 1040 or Form 1040 A) and corresponding W-2 or 1099

earnings summaries. If applicant is not required to file an income tax return, then

additional documentation is required (see attached).

7.) Scholarships will not be reviewed and awarded unless the application form is

completely filled out, properly submitted by the due date stated on the form.

8.) Any individual that withdraws or is expelled from a class, or attends fewer than

75% of all classes for which they are receiving scholarship monies shall not be eligible

to receive future scholarship monies from the S.T.A.R. program unless there are

extenuating circumstances.

9.) After the family receives notification of scholarship award it is the family’s

responsibility to make initial payments to the SullivanCivicCenter for Dance

Classes and to The Little Theatre On The Square for Drama Classes.

10.)Registration Fees and Costume Fees are not included in the amount of

Scholarship Award.

The Little Theatre On The SquareSullivan Civic Center

P.O. Box 288600 N. Washington

Sullivan, IL61951Sullivan, IL 61951

217-728-2065217-728-4541

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Additional Documentation Required

When Applicant has No Federal Income Tax Return & W-2 Forms

Applicants who are exempt from filing a Federal Income Tax Return or are unable to provide

corresponding statement of income, must provide copies of the following applicable documentation

for all household members in order to be considered for tuition waivers:

1.)Checking and Savings account statements for previous two months.

2.)SSA/SSI Award Letter (Disability Income).

3.)Proof of unemployment benefits for previous two months indicating

amounts received.

4.)Proof of Application for/or Receipt of Benefits from IDHS (Public

Aid or Food Stamps)

5.)Workman’s Compensation for previous two months indicating amounts

received.

6.)Copy of Divorce Decree including alimony and child support amounts.

Low-Moderate Income Guidelines

Application for S.T.A.R. Scholarship

Number Of Persons In Household / 25% Scholarship Eligibility / 50% Scholarship Eligibility / 90% Scholarship Eligibility
Yearly Income / Yearly Income / Yearly Income
1 / $22,345-$17,225 / $17,224-$12,104 / $12,103-$0
2 / $29,977-$23,108 / $23,107-$16,238 / $16,237-$0
3 / $37,609-$28,991 / $28,990-$20,372 / $20,371-$0
4 / $45,241-$34,874 / $34,873-$24,506 / $24,505-$0
5 / $52,873-$40,757 / $40,756-$28,640 / $28,639-$0
6 / $60,905-$46,840 / $46,839-$32,774 / $32,773-$0
7 / $68,137-$52,523 / $52,522-$36,908 / $36,907-$0
8 / $75, 409-$58,406 / $58,405-$41,402 / $41,401-$0