Scholarship Form – Casper Children's Theatre

Performer's First and Last Name*
Parent's/Guardian's First and Last Name*
Primary Email Address*
Primary Mailing Address*
Primary Phone Number*
Performer's Birthday: MM/DD/YY*
Household Annual Income Level*
(Include income from work, welfare, child support, alimony, pension, social security and disability, and any other sources)
How did you hear about the Michael & Ebba Stedillie Scholarship?*
Please write a brief paragraph or more (a minimum of 8 sentences) explaining why you (or your performer) should receive the Michael & Ebba Stedillie Scholarship. Reasons can include anything from your passion for the theatre, your desire to try something new, financial need, and much more. Be creative, honest, and personable in your response.*

307.215.8922
949 N. Durbin
Casper, WY 82601