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Music Travel Scholarship Application
Student Information:
Student Name: ______________________________________________________ Grade: _______________________
Parent/Guardian Name: ____________________________________________________________________________
Mailing Address: _________________________________________City/Zip__________________________________
Parent Day phone: _________________________________ Parent Cell phone: _______________________________
Parent Email: ____________________________________ Preferred Contact Method: Day phone Cell Email
School: ______________________________________________ Music teacher: ______________________________
Preference for accepting scholarship if awarded:
Mail scholarship to home address
Pick scholarship up from Humboldt County Office of Education (901 Myrtle Avenue, Eureka Ca 95501)
Scholarship Criteria:
Please attach a copy of your invitation to attend and proof of registration.
Music Event: _____________________________________________________________________________________
Specific dates of event: __________________________________ ______
Where is the event (city/venue)? ___________________________________________________________________
Scholarship Requested (Please choose one):
(If applying for a travel scholarship event must be 100 miles from HCOE)
$100 Registration Scholarship
$200 Travel Scholarship
$300 Registration and Travel Scholarship
Note: If an unexpected problem arises and the student is unable to attend the scholarship must be returned.
Request for scholarship must be received no less than 15 days prior to the event to:
Olivia Kernen, Humboldt County Office of Education, 901 Myrtle Ave., Eureka, CA 95501
707-445-7007email: okernen@humboldt.org