Mien van Heek Memorial Scholarship
APPLICATION FORM

(or pdf. version)
Applicants, or their parent(s), must be current members of Theatre BC. 
Recipients will be announced at the MAINSTAGE Awards Ceremony.

Name: ______________________________________________________________________________

Theatre BC Club Card Membership Number (yours or a parent's) : ______________________________

Mailing Address: ______________________________________________________________________

City: ___________________________________________________ Postal Code: _________________

Home Phone: ___________________________ Cell or Work Phone: ___________________________

email address: ________________________________________________

Date of Birth: __________________  How long have you resided in BC? (years/months) ____________

What is the name and location of the school and course of study to which you have applied?

____________________________________________________________________________________

____________________________________________________________________________________

Estimated Expenses for Theatre Studies

Tuition Fees:		$_______________
Books & Supplies:		$_______________
Room & Board:		$_______________
Transportation:		$_______________
Miscellaneous (Please itemize):
_________________		$_______________
_________________		$_______________
_________________		$_______________
	TOTAL:	$_______________

Are there any special circumstances which make it necessary for you to apply for assistance? Please explain:
___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Please Attach:

1. TWO Letters of Reference from people who are familiar with your interest and experience in theatre;
2. A letter of acceptance, or a confirming receipt of registration from a recognized Canadian post-secondary theatre department.
3. A letter stating your reasons for pursuing further theatre training.
4. A statement of theatre experience or theatre resume with specific reference to previous community theatre involvement.
5. Copy of previous transcript of post-secondary training.
6. A recent photo of yourself.

Deadline For Receipt of Applications:  June 1st

I hereby declare that the above information is to the best of my knowledge correct and complete.

___________________________________________________ Date: ___________________________
Signature of Applicant

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