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Jessie L. Richardson & Sid
Williams Memorial Scholarships
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? ____________________________________________________________________________________ ____________________________________________________________________________________
If under 19 years of age, please list full name(s) and address(es) of your parent, guardian or sponsor: ___________________________________________________________________________________ ___________________________________________________________________________________ Are there any special circumstances which make it necessary
for you to apply for assistance? Please explain: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Please Attach:
DEADLINE For Receipt of Applications: Monday, June 1st, 2009I hereby declare that the above information is to the best of my knowledge correct and complete. ___________________________________________________ Date:
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Eric Hamber Award
Nomination Form / Past Eric Hamber Award Winners
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