Name: _________________________________________________________________________________ Address: _____________________________________________

Phone: (_____) _______ ___________

City: ___________________________________________

State: ________ Zip: ________________

Parent/Guardian Name: ___________________________________________________________________

Grade: _______ School: _____________________ E-mail: ___________________________________

DOB: _________________________ Age: ___________ Gender (Circle One): F M

Please check the box if the answer to the following questions is yes:

Do you require federal assistance for housing?

Do you use WIC?

Does your household use food stamps?

Annual Household Income: $ ____________________ Use this space for any additional information, if necessary.

By signing, the above information is true and correct.

Student Signature________________________________________

Parent Signature_________________________________________ (If under 18 years of age)

Sioux Falls Jazz and Blues JazzFest Jazz Camp 2017Scholarship Application

(Please use black ink and print clearly)

We want you to go camping! Together we can make this happen. Completing this form is your first step toward ensuring that you will be joining us for the best week of your life. Plase answer accurately, andsomeone will be in touch. If you have questions, contact Sioux Falls Jazz & Blues at 605.335.6101.

2017 JAZZ CAMP SCHOLARHIP APPLICATION

It is the mission of Sioux Falls Jazz & Blues to increase the awareness of Jazz and Blues music in our region through musical events and education.

Sioux Falls Jazz & Blues is a 501 (C) 3 non-pro�t arts organization.

2017 JAZZ CAMP SCHOLARHIP APPLICATION

Complete the Scholarship Application form and mail by June 15, 2017 to:

JazzFest Jazz CampC/O Sioux Falls Jazz & Blues 301 S Main Ave PO BOX 1285Sioux Falls, SD 57101-1285

Sioux Falls Jazz and Blues JazzFest Jazz Camp is locatedon the campus of University of Sioux Falls in SiouxFalls, SD.

Application and enrollment implies agreement to abideby all JazzFest Jazz Camp and University of SiouxFalls rules and regulations (also available online atjazzfestsiouxfalls.com/jazzcamp).