Elementary_Secondary Scholarship Application First Name * Last Name * Middle Address * City * State * Zip * Home Phone Cell Phone Email * A copy of your completed form will be sent to this address as well as any future correspondence. U.S. Citizen? * Yes No Social Security Number * Institution where scholarship will be applied OMC member contact and relationship OMC member phone Name of school now attending Name of school or continuing education program planning to attend School I.D. (if available) Year or grade currently in school Activities: List any awards, honors, scholarships, etc. you have received Briefly outline your goals (musical or otherwise) CERTIFICATION I hereby agree that applicant is applying for a grant from the Orpheus Scholarship Program and that all information in this application is true and accurate to the best of my knowledge. I further agree that if an award is made, I will use it entirely for the purposes specified in the grant award. I acknowledge that all award funds will be distributed to my selected institution and made available in accordance with their dispersal process and the grant stipulations. Grant money will NOT be issued directly to the awardee and any exception will require unanimous approval from the Orpheus Board of Directors. I hereby agree that during the term of my award and for one year thereafter, any performance by me in conjunction with The Orpheus Male Chorus of Phoenix will be uncompensated unless otherwise agreed to by normal board action and that, in any case, Orpheus will retain all rights of use of any such performance in perpetuity. Signature Clear A copy of your completed application will be emailed to you when you SUBMIT your application. Submit Application If you are human, leave this field blank.