Student Application Form

Lloyd S. Kaplan Music Scholarship

Instructions: Please print clearly or type. Return completed form to:

CCRI Foundation Lloyd S. Kaplan Music Scholarship
c/o Music Department
Community College of Rhode Island
400 East Avenue, Warwick, RI 02886-1807

Applications must be hand delivered by 4 p.m. or postmarked no later than August 15.

Name__________________________________________ Student I.D. #______________________

Address______________________________ City_________________ State____ Zip____________

Telephone_______________________________ email_____________________________________

1. Are you currently enrolled in the A.F.A. Music program? Yes__ No__

2. Are you currently enrolled in the A.F.A. Jazz Studies program? Yes__ No__

3. Are you an entering freshman at CCRI? Yes__ No__

4. Are you at continuing at CCRI? Yes__ No__

5. Are you attending to study as a: Instrumentalist? _____ Which instrument? _________________

Vocalist? ______ Voice range?______________

6. Have you submitted: letter of recommendation from your private music teacher? Yes__ No__

7. Have you scheduled an audition for the Music Faculty at CCRI? Yes__ No__

I grant my permission to the Scholarship Review Committee to review my academic standing with CCRI’s Office of Admissions and Records, to review my financial need with CCRI’s Financial Aid Office, and to use my name and photo for publicity purposes.

________________________________
Student Signature/Date

Important Note: Scholarship recipient is required to write a thank you note (memo and sample thank you note) to the scholarship donor, and provide a brief biography (printable bio form) about themselves and their education/career goals and return both to: Geraldine Peixoto, CCRI Foundation, Flanagan Campus, 1762 Louisquisset Pike, Lincoln, RI 02865. Please contact the CCRI Foundation if you need assistance in completing this responsibility at 333-7150 or e-mail at foundation@ccri.edu.