Montpelier, VT 05601

Name_______________________________Age_

Address______________________________________________

City____________________________ State_______Zip_______

Phone ______________________________________________

Email Address ________________________________________

School Attending _____________________________________

Grade Level____________ Male Female (circle one)

Birthday _____/____/_____

Parents Name________________________________________

Previous Theater Training (optional) ____________________

_____________________________________________________

What program will the scholarship be used for?__________

_____________________________________________________

What is the cost and dates of the program?

_____________________________________________________

Name of contact person at camp?

_____________________________________________________

Please write a 200-250 word statement describing what you hope to learn in the workshop/camp.

_____________________________________________________

Applications must be post-marked by May 3rd.

Please send your completed application to:

TAFFY, PO Box 465, Montpelier, VT 05601