Scholarship Application

Please print out this page and mail it with your application and audition fee to

WVYO Chamber Music Camp with Quartet Sabaku
P.O. Box 206, Litchfield Park, AZ 85340-0206
Please make checks payable to West Valley Youth Orchestra
Registration due May 14, 2010. Auditions are May 22, 2010

WVYO WVYO Chamber Music Camp with Quartet Sabaku Scholarship Application

Name of Music Student: _________________________________________________
Birth Date: _____________________________________________________________
Address: _____________________________________________________________
City: ___________________________State _____________Zip _________________
Phone: _____________________________________Email:_____________________
Instrument: _______________________Number of years played: _________________
Name of school string teacher:_____________________________________________
Private lessons? Yes No (Circle one)
Teacher_______________________________Phone___________________________
Is applicant participating in other musical experiences out of school? ______________
Explain: _______________________________________________________________
Name of Parents: _______________________________________________________
Applicant lives with (circle one): Mother only Father only Both parents Other
Father’s employment/title: ________________________________________________
Mother’s employment/title: ________________________________________________
Total gross family income from ____________(year) $_________________________
Number of dependents at home: _______________
Youth Orchestra participation: _____________________________________________

I hereby certify that all the information supplied in this application is true. Parent/Guardian Signature: _______________________________Date: _____________ Please mail with your application to WVYO, Music Camp Director, Box 206, Litchfield Park, AZ 85340