Holyoke Creative Arts Center
Scholarship/Grant Application Form

To find out if you qualify for a scholarship, please fill in the information, print it, and then mail, fax or bring it to the Center.
P.O. Box 4998, Holyoke, MA 01041 - Fax: (413) 532-2278

A. Persons in your Household (including yourself):

B. For the group corresponding to your family size above, please check if your Household Income falls below this level. (If not, leave blank)

Family Size

1 person

5 persons

$10,950    $18,250

$20,160    $29,200

$16,900    $28,150

$31,080    $45,000

2 persons

6 persons

$12,500    $20,850

$23,040    $33,350

$18,150    $30,200

$33,420    $48,350

3 persons

7 persons

$14,050    $23,450

$25,920    $37,500

$19,400    $32,300

$35,700    $51,700

4 persons

8 persons

$15,650    $26,050

$28,800    $41,700

$20,650    $34,400

$38,040    $55,000

CLASS:

DAY: TIME: SESSION:

NAME: TEL. NO.

ADDRESS:

ETHNIC BACKGROUND:

DATE: SIGNATURE: _________________________________