Scholarship Application

PLEASE FILL OUT THIS FORM COMPLETELY AND SUBMIT WITH THE REQUIRED ITEMS AT LEAST
3 WEEKS PRIOR TO THE FIRST DAY OF CLASS TO:

Scholarship Administrator
Wildfish Theatre Company
1703 D-1 Post Oak Blvd
Houston, TX 77056

Date of Application: __________________________________

Class Session: ( ) Fall ( ) Spring ( ) Summer I ( ) Summer II ( ) Summer 3 ( ) Other (specify) _________________

Scholarship Guidelines:
• Applicants are evaluated without regard to race, religion, natural origin, sex or physical ability.
• Funding is limited and scholarship are not guaranteed to all applicants
• Scholarship may not be awarded two years in a row.
• Incomplete applications will not be reviewed.
• Scholarships will be awarded based on need and merit.

Scholarship Recipient Requirements:

Submit completed application
Submit financial documentation demonstrating need
Complete and submit follow-up report (attached) and/or letter after the class session

Please fill out one form per child.

Name of Child ___________________________________________ Birth date __________ / __________ / __________

Mailing Address __________________________________________ City ____________________ Zip _______________

Phone ( __________ ) ______________________ Family Email ______________________________________________

Grade _____________________________ School _________________________________________________________

What do you hope your child will gain from this experience? _____________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

What is your previous experience at Wildfish Theatre? ___________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

How many children currently live in the household? __________ Please list their ages: _______________________
REQUIRED FAMILY INFORMATION

Father’s Name _______________________________________________________________________________________

Address (if different) _________________________________________________________________________________

Place of Employment _______________________________Position _________________________________________

Mother’s Name _____________________________________________________________________________________

Address (if different) _________________________________________________________________________________

Place of Employment _______________________________Position _________________________________________

Name of Legal Guardian (if not living with mother/father) _________________________________________________

FINANCIAL INFORMATION
Total Household Size Yearly Income Monthly Income

Eligibility for need-based 2 $! 25,900 $! 2,159

scholarships is based on the
3 $! 32,560 $! 2,714
following criteria and
conditions, including 4 $! 39,220 $! 3,269
household size and income
standards. If an applicant 5 $! 45,880 $! 3,824
does not fall within these 6 $! 52,540 $! 4,379
criteria but can prove other
special circumstances, the 7 $! 59,200 $! 4,934
scholarship committee will
8 $! 65,860 $! 5,489
review that information.

Please indicate your total annual income from all sources (including wages, interest income, investments, alimony, child
support, social security, public assistance).

( ) Below $10,000 ( ) $20,001-$25,000 ( ) $35,001-$40,000 ( ) $50,001-$55,000

( ) $10,001-$15,000 ( ) $25,00 - $30,000 ( ) $40,001-$45,000 ( ) $55,000-$60,000
( ) $15,001-$20,000 ( ) $30,001-$35000 ( ) $45,001-$50,000 ( ) $65,001-$70,000
( ) over $70,000

Are there any extenuating circumstances, permanent or temporary, that make financial assistance necessary at this
time?
____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Has anyone in your family previously received financial assistance through our scholarship fund? ( ) Yes ( ) No

If yes, when? _______________________ How much was received? $ __________________________

Fee amount you are requesting: $___________________________

Amount you can you contribute: $___________________________

If you have any questions, please contact us at [email protected]

 CLASS FOLLOW-UP REPORT
(Due 30 days after completion of Class Session)

PLEASE FILL OUT THIS FORM COMPLETELY AND SUBMIT TO:

Scholarship Administrator
Wildfish Theatre Company
1703 D-1 Post Oak Blvd
Houston, TX 77056

Name of Child ___________________________________________ Birth date __________ / __________ / __________

Mailing Address __________________________________________ City ____________________ Zip _______________

Phone ( __________ ) ______________________ Family Email ______________________________________________

Grade _____________________________ School _________________________________________________________

Which Class Session did your child attend? ___________________________________________________________

What did your child learn or gain from this experience? __________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

What was your child’s favorite part of the class? ________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

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