DEPARTMENT OF THEATRE SCHOLARSHIP APPLICATION FORM FOR BA THEATRE STUDIES MAJORS Submit application by 4 pm, Friday, March 31, 2017, PAB 206

The following items are required for all scholarship applications:

• Minimum of a 3.0 Grade Point Average (GPA)  A recent Degree Audit Report (DARS).  A list of any other scholarships you have received and will continue to receive.  A paragraph describing your progress in your program of study, and service to Department or community—e.g., outreach to schools, participation in SAC, etc.  You must be a Theatre Major enrolled for at least 12 credit hours each semester in order to be eligible for a scholarship.  You must sign and return the attached U of U Financial Aid and Scholarship form.

Name Student ID#

E-mail Address

Cumulative GPA

Current Address

Zip Code Permanent or Parents’ Address where to send mail this summer

Zip Code Phone # Cell Phone #

Your year in the program 2017-2018 Circle one: Freshman Sophomore Junior Senior

A copy of this application will be forwarded to the Department Scholarship Selection Committee. Incomplete or late applications will not be considered.

Privately Funded Scholarships, Fellowships, or Other Financial Aid

Certain privately funded scholarships are exempted from the general state law that requires certification of U.S. citizen or lawfully present non-citizen status. If a student graduated from a high school within the state of Utah and is applying for only privately funded awards that are administered by the University of Utah, no certification is required.

Please indicate below your high school graduation status:

o I graduated from a Utah High School o I did not graduate from a Utah High School

Print Name Student ID

IF YOU GRADUATED FROM A UTAH HIGH SCHOOL, YOU DO NOT NEED TO COMPLETE THE REMAINDER OF THIS FORM.

If You Marked “I Did not graduate from a Utah High School” please complete and sign below:

Any student who did not graduate from a Utah high school and who receives a scholarship, fellowship, or other privately-funded financial aid administered by the University of Utah is required by state law to certify that they are eligible to receive the scholarship as a U.S. citizen or a citizen of another country who is lawfully present in the U.S. The student’s status will also be verified with the Department of Homeland Security. If students do not know whether they are in the U.S. lawfully, they should seek the advice of an immigration attorney before accepting a scholarship award that requires certification and verification.

Student Citizenship Status (Check one of the following): o U.S. Citizen o Lawfully Present, Non-Citizen of the U.S.

By selecting above either “U.S. Citizen” or “Lawfully Present, Non-Citizen of the U.S.” and by signing this application, I certify under penalty of perjury that I am either a U.S. citizen or a citizen of another country who is lawfully present in the U.S. I understand that my status and eligibility for financial aid/scholarship within the U.S. will be verified through the Department of Homeland Security prior to an award of this scholarship/financial aid. This federal agency may have the legal right to share the information with other government agencies.

Applicant Signature

State or Federally-Funded Scholarships, Fellowships, or Other Financial Aid

Any student who receives a scholarship, fellowship, or other state or federally- funded financial aid administered by the University of Utah is required by state law to certify that they are eligible to receive the scholarship as a U.S. citizen or a citizen of another country who is lawfully present in the U.S. If students do not know whether they are in the U.S. lawfully, they should seek the advice of an immigration attorney before accepting an award of financial aid that requires certification and verification.

Student Citizenship Status (Check one of the following):

o U.S. Citizen o Lawfully Present, Non-Citizen of the U.S.

Prior to the disbursement of any scholarship/financial aid, the University of Utah is required by law to verify with the Department of Homeland Security (DHS) the lawful presence in the U.S. of students who are not U.S. citizens. Once the University submits a student’s information to DHS for verification, this federal agency may have the legal right to share the information with other government agencies.

Print Name Student ID

By signing this application, I certify under penalty of perjury that I am either a U.S. citizen or a citizen of another country who is lawfully present in the U.S. I understand that my status and eligibility for financial aid/scholarship within the U.S. will be verified through the Department of Homeland Security prior to an award of this scholarship/financial aid.

Applicant Signature FERPA NOTICE: The Family Educational Rights and Privacy Act of 1974 (FERPA), governs the release of records maintained by an institution of higher education and access to student records. Generally, without a student’s written consent, the University of Utah may not disclose information from a student’s educational records. For additional information regarding FERPA, please see http://registrar.utah.edu/handbook/ferpa.php.

The University of Utah wishes to disclose the following information regarding each scholarship recipient to the donor(s): name, private teacher, performance ensembles, instrument(s)/voice type, degree(s) and/or minor(s), post- graduation plans, and anticipated graduation date. Therefore, we request your written permission to release that information to the donor(s). By signing below, you give permission for the University of Utah to release the specified information. You may revoke this release at any time by giving written notice to the Department of Theatre Scholarship Coordinator.

______Signature

______Date

______Name (please print)

______Student ID#