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VSA arts of Nevada Scholarship Application
PRE-REGISTRATION REQUIRED ON ALL CLASSES
Please send application with registration form to VSA arts of Nevada.
Fax to 337-6107 or mail to 250 Court St, Reno, NV 89501

Name ______________________________________________Date _____________________

Address _____________________________________________________________

City, State, Zip __________________________________     Phone_______________________

Employer _____________________________          Work Phone _________________________

Cell #________________________                         e-mail address ________________________

If application is for a child, please complete next section.

Name ______________________________________________ Age ______________ 

School _____________________________________________ Grade _____________

Please list class(es) including date, and location that you are interested in taking.

____________________________________________________________________________________

Do you/your child have a disability?   ________________________________________

What is your monthly gross income from employment? __________________ 

Other source of income or public assistance?    _____yes    ______no 

If yes, please list source and monthly________________________________________ 

# of people in your family __________________ Amount requested:  $_________________