Student Name:

Date of Birth:

Age:

Student Address:

City:

Zipcode:

Student Phone:

Cell Phone:

High School:

Grade:

Teacher:

School Phone:

Check the Scholarship/Award you are applying for (you may check more than one)

Osborne Scholarship

Betty Beeby Scholarship

JRAC Award

I plan on going to college to study art: Yes       No

If you answered yes, list the college/university you have applied to:

(please note “yes” if you have been accepted to the college/university)