Miss Patti's School of Dance
Scholarship Application

Please print this application, complete it, then mail, fax or drop it off at the dance studio's office:

85 Godwin Avenue
Rear of Midland Park Shopping Center
Midland Park, New Jersey 07432
Phone: 201-670-4422
Fax: 201-670-5022

Parent (Guardian) Name: _____________________________________________________

Street: _______________________________________

City: _______________________________ State: ________________ Zip: ____________

Home Phone: ____________________ E-Mail: ___________________________________

Student Name: __________________________________________ DOB: _____________

Briefly describe the student's dance background/experience:

Briefly describe why you are seeking a scholarship:

Shortly after the Scholarship Application is submitted, you will be contacted for an interview. THANK YOU!