HERB STREITZ MEMORIAL BAND FUND by 5nAkG24

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									                          HERB STREITZ MEMORIAL BAND FUND
                           Waseca Area Foundation Application Form

Date _______________

Name of Student________________________________________________________________

Name of Parent(s)/Guardian(s) ___________________________________________________

                                       ___________________________________________________

Student Address ________________________________________________________________

______________________________________________________________________________

Parent or Guardian Phone:             Work_________________________
                                      Home ________________________

Names of Siblings in Band (at any Waseca school):

___________________________________________

___________________________________________

___________________________________________

Number of Total Persons in Household _________

Annual or Monthly Family Gross Income $______________ per year

                                              $_______________per month

Student applicant’s current year band expenses:
        Rent or Purchase of Instrument $______________
        Band Trip Expenses              $______________
        Band Camp Registration          $______________
        Performance Clothing            $______________
        Other                           $______________
Please attach bills or receipts.

Amount of request $______________
For: Rent or Purchase of Instrument                $______________
     Band Trip Expenses                            $______________
     Band Camp Registration                        $______________
     Performance Clothing                          $______________
     Other                                         $______________

Please attach bills or receipts.
See Herb Streitz Scholarship Grant Guidelines regarding policy limits.


             Return completed form to the Waseca High School Guidance Office.
      For more information contact Karen Buum at Waseca Area Foundation at 835-5990.

5bf98d28-3104-40a5-b952-2144de248643.doc

								
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