Louisville Youth Orchestra

Scholarship Application
2016-2017 Season
Read the Scholarship Rules posted on our website at www.lyo.org before applying!
This scholarship application plus tax return must be postmarked by Monday, September 26, 2016.
A $100 check MUST accompany this application as partial membership fee payment.
A copy of your familys most recent 1040 tax return indicating adjusted gross income must be attached
to this application. Without this tax return your application will NOT be considered.
Scholarships are awarded on the basis of need. Applicants must be members in good standing.
Return to the Louisville Youth Orchestra, P.O. Box 997, Louisville, KY 40201-0997.
If awarded a private lesson scholarship, the Parent Verification and Teacher Verification forms must be
postmarked by Monday, October 31, 2016 or award will be revoked. NO EXCEPTIONS!
Applicants Name ________________________________________________________________________
Applicants FULL Address (Street, City, Zip) ___________________________________________________
______________________________________________________________________________________
Applicants Phone Number ________________________________________________________________
Scholarship(s) Requested:
1. __________ Louisville Youth Orchestra membership fee
2. __________ Scholarship funds for private music lessons
List below the name, address and phone number of private music teacher:
Name______________________________________________________________________________
Street______________________________________________________________________________
City ______________________________________ State____________________ Zip _____________
Phone _____________________________________________________________________________
Please provide the following financial information.
____________________________________ ___________________________ ____________________
Father or Guardian Name
Occupation
Annual Income
____________________________________ ___________________________ ____________________
Mother or Guardian Name
Occupation
Annual Income
Amount of any monthly support payments ... ___________________________
Total number of people living in household .. ___________________________
Total annual income of family unit . ___________________________
Signature of Parent or Guardian ____________________________________________Date ____________
Please use the back of this form to add any comments that might be important.
Questions? Call 1-502-896-1851