Please attach
passport-size
photo
 
 
Ethel Ramos Harris
Artistic Achievement Award Fund

APPLICATION

(Please print or type and identify your name at the top of each page)

 

Name: ________________________________________________________________
Date of Birth: ____________________
Place of Birth: _______________________________
 
Permanent address:
Street: _________________________________________
City: _________________________
State: ________
Zip Code: ___________
Telephone: (H)______________________ (W)____________________

 
Current address:
Street: _________________________________________
City: _________________________
State: ________
Zip Code: ___________
Telephone: (H)______________________ (W)____________________
 
Educational background:
High School ___________________________________Graduation Date____________
University/College (if applicable)____________________________________________
Years attended _________________ Degree ___________Year awarded___________
 
Training/Additional Education: (Please give dates)(Please use continuation sheet if needed.)
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
 
Awards/Achievements: (Please use continuation sheet if needed.)
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
 
How would receiving this award enhance your development as a classical pianist? (Please use continuation sheet if needed.)
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
 
Please provide Biographical Statement using the Biographical Statement form.
 
I certify that all documents and material submitted in the application package are true and correct.
 
Date: _________________________________________
Signature: ________________________________