APPLICATION for July 2010 Award Please read carefully the Guidelines for Applicants before completing this form. Type or write in black or blue ink using only the space provided, except where indicated otherwise. Please submit only one application.
	Application deadline: May 31, 2010. Return completed application to: CAPA, c/o ImageSource, P.O. Box 55, Mountain View, CA 94042.
PERSONAL DATA First name Last name Address City State Zip code Daytime phone Work phone Email Resident of California since: month_________ year_________ Age_____
EDUCATIONAL HISTORY Please list your educational/training background, beginning with the most recent institution where you have studied (specify location), from secondary school onwards. Indicate the courses, dates attended, and level achieved. Please list private dance-related instruction, including where and with whom, and course length. AWARDS and GRANTS Please list any previous scholarships, grants, awards, or public sector funding received, including the year and amount of each. PROPOSED TRAINING Briefly describe the course you are applying for, including the title, location, date of enrollment or start date, and course content. Why do you wish to attend this training course? Please clearly describe your career development goals, and how you feel this training opportunity would help you work towards achieving those goals. DECLARATION [   ] I am a US citizen and resident of California. I hereby declare that all statements made by me on this form are true and the work enclosed is my own. I further declare that I will use any funds awarded to me solely for the purposes stated herein, and will provide a written report within 30 days after beginning my dance instruction. If I am the recipient of a Jason Robins Dance Scholarship, I agree to allow Jason Robins Dance Scholarship Fund and CAPA to use my name and photo for publicity purposes. Signature Date CHECKLIST [   ] Completed application form [   ] Copy of transcript with current GPA status [   ] Background information about the course [   ] 3 Formal letters of recommendation [   ] Other supporting materials (optional), e.g. videos, photos, writing samples (All clearly labeled with your name; please enclose a self-addressed envelope with sufficient postage for return.) Send your application to: CAPA, c/o ImageSource, P.O. Box 55, Mountain View, CA 94042 APPLICATIONS MUST BE RECEIVED BY MAY 31, 2010.
Jason Robins Dance Scholarship · www.robinsdesign.com/dance · email: dance@robinsdesign.com CAPA · c/o ImageSource Presentation Systems · P.O. Box 55, Mountain View, CA 94042