SUMMER ARTS GRANT APPLICATION FORM DESCRIPTION

(This Application may be reproduced.)Administrative OfficesP.O. Box 2, 630 Route 217Mellenville, NY 12544PHONE 518·672·4451FAX 518·672·0187EMAIL info@coarc.orgwww.coarc.orgSUMMER ARTS GRANTAPPLICATION FORMDESCRIPTION:Summer Arts Grants will be awarded annually to school-aged applicants meeting the following criteria:1. Applicants must be residents of Columbia County.2. Applicants must be enrolled in a special education program in Columbia County.Grant money must be used to defray tuition or other expenses incurred by the recipient in taking art, music, ordance lessons during the summer months.APPLICANT'S NAME: ____________ ~DATE OF BIRTH: ______ _HOME ADDRESS: __________________________ _TELEPHONE: _________ SCHOOL: _______________ _CSE CLASSIFICATION: _______________________ _SIGNATURE OF PERSON VERIFYING CLASSIFICATION: ____________ _TYPE OF ART, MUSIC OR DANCE LESSONS FOR WHICH THE GRANT MONEY WOULD BEUSED:NAME, ADDRESS AND TELEPHONE NUMBER OF ART, MUSIC OR DANCE TEACHER WHO WILLTEACH THE SUMMER LESSONS:Coarc is a chapter of NYSARC, Inc., and a member ofThe Arc of the United States, the New York RehabilitationAssocation, Inc. (NYSRA), and the New York State Association of Community and Residential Agencies (NYSACRA).Co arc is a 501 (c)(3) nonprofit organization.

SUMMERARTS GRANTPage2Application FormAPPLICANT'S STATEMENT OF INTEREST- PLEASE COMPLETE THE FOLLOWINGSTATEMENT: I WOULD LIKE TO TAKE ART, MUSIC OR DANCE LESSONS BECAUSESPECIAL EDUCATION TEACHER/INSTRUCTOR'S REFERENCE- PLEASE COMPLETE THEFOLLOWING STATEMENT: IT THINK THAT THIS APPLICANT SHOULD BE CONSIDERED FORTHIS AWARD BECAUSESignature of Instructor/TeacherDateAddressTelephone NumberDEADLINE FOR APPLYING: MAY 1, 2013. PLEASE MAIL COMPLETED APPLICATION TO:SUMMER ARTS GRANT, C/0 COARC, P.O. BOX 2, MELLENVILLE, NEW YORK 12544