501.3c Tax Exempt Organization 
c/o SLHS Choral Department 11400 South Lakes Drive Reston, VA  20191 
slhschorus@gmail.com 
South Lakes High School’s Chorus Boosters  

PCA Student Scholarship Application for Spring Trip 2013
(STRICTLY CONFIDENTIAL) 

STUDENT NAME: ________________________________________________________________   YEAR ___________ 
PARENT/GUARDIAN NAME: ____________________________________________________________________________ 
HOME PHONE #: _________________________ PARENT PHONE #: _________________ / CELL#___________________ 

PCA will provide 50% of the Spring Trip cost for students awarded a scholarship.  Estimate split for student and PCA is $350.  This application and deposit of $100 is due on January 23, 2013.

PARENT/S EMAIL: _____________________________________________________________________________________ 
1	Please provide names of three fundraisers you have/will participate in during the year to help the PCA raise $

1)	_______________________________________________________________________ 

2)	_______________________________________________________________________

3)	_______________________________________________________________________

2	Briefly explain below your financial need which requires assistance. (This information will be kept in strictest                        confidence). 

3	For a Spring Trip Scholarship: Please have your student write a brief paragraph describing why she/he deserves to receive a scholarship for this year’s trip.  Attach the paragraph to this application when you submit your request. 

4	Payment due at time of application is $100.00.  A payment schedule will be provided to students before January 31, 2013 with remaining scheduled payment dates.
Thank you for making an application for a PCA Student Scholarship. 
The PCA Chorus Boosters try to assist as many students as possible each year to meet their financial obligations to the Choir.  Please return this form directly to Mrs. Gigliotti in the Chorus Room, or mail it to the address listed above.  You will be notified by telephone and/or e-mail when a decision has been made.  First received, first considered!