Name of Applicant:
Home Address:
City:
State:
Zip:
Daytime Phone:
Email:
Company and Theatre Name:
Theatre Phone:
Supervisor's Name:
Supervisor's Phone:
Theatre Address:
City:
State:
Zip:
Are you currently:
A High School Senior
In College
Returning to School
Where do you intend to use this scholarship (school name):
What is the name of the school you are currently attending:
Digital Signature (type name):
Date:
2017 NATO of CA/NV
Dependent Child Scholarship Application
__________________________________________________________________________________________________ The following information is related to qualifying parent and his/her employment:
Name of Parent:
Supervisor's Email:
Employee Digital Signature (type name):
Date:
Hire Date:
Start Date as General Manager:
By my signature below I acknowledge that Applicant is my legal, dependent child and if Applicant is selected to receive a scholarship I may be required to provide a copy of my most recent Income Tax Return as verification. In addition, I authorize the HR Department of my company to verify the information provided by me on this application.