Date of Application: _______________________

Name of Applicant: _________________________________ Phone: ____________

Street Address: _______________________________ Email: _________________

City/State/Zip:___________________________________ Date of Birth: ________

High School Attended:____________________________ Year Graduated: _______

College Attending: ___________________________________ (Attach acceptance letter.)

Area of Study:_________________ Anticipated Graduation Date: ___________

Grade point average:_________________

Attach a brief statement describing how this award will help you

Reference (art educator or artist):_______________________________________________

Reference Address:__________________________________________________________

Reference email:_________________________________Phone:______________________

Give completed application to your guidance counselor or mail it to:

SBA
PO Box 7100
Ocean Park, ME 04063