DOROTHY L. RIEKES MUSIC & CULTURAL ARTS SCHOLARSHIP

The current program requirements include the following:

Scholarships are awarded on a financial-need basis.
Scholarships are available only to Jewish residents of the Omaha metropolitan area.

To apply for a Dorothy L. Riekes Music & Cultural Arts Scholarship, complete this application in full.

Applications must be submitted a minimum of TWO WEEKS before the event or registration date.

Questions? Contact:
Diane Walker
(402) 334-6551
dwalker@jewishomaha.org

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Student Name*
First Middle Last
Preferred First Name
Gender*
Date of Birth*
MM slash DD slash YYYY
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Parent/Guardian Email*
Marital Status*
- Married
- Divorced
- Single
- Widowed
Other dependents*
If you have other dependents, please list names and ages.
Dependents attending college*
If any dependents are attending college, list name of dependent & name of college.
Synagogue Affiliation*
To which Omaha synagogue does your family belong?

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Program Information
Which type of program are you applying for?*
- Music: Vocal
- Music: Instrumental
- Cultural Arts: Dance
- Cultural Arts: Art
Which instrument(s)?*
How long has the student been involved?*
How long has the student been taking lessons?*
Performances/Shows*
Please describe performances and/or shows in which the student has participated.
Student's Musical/Cultural Arts Goals*
What are the student’s musical/cultural arts goals?
Program / Instructor Name*
Total Program Cost*

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Financial Data
FINANCIAL NEED WITHIN THE FAMILY UNIT IS THE PRIMARY CONSIDERATION IN AWARDING SCHOLARSHIPS.
Financial Conditions*
PLEASE EXPLAIN IN DETAIL THOSE FINANCIAL CONDITIONS THAT YOU FEEL SHOULD BE BROUGHT TO THE ATTENTION OF THE FINANCIAL AID COMMITTEE. Examples could include, but are not limited to, the following: parents and/or siblings also attending college; support of family member outside of the immediate family; excessive educational debt; excessive medical debt; serious medical issues affecting the family; significant loss of income in the past year; single parent with little or no income from the absent parent, etc. THE MORE COMPLETE THE INFORMATION, THE BETTER ABLE THE COMMITTEE IS TO MAKE A FAIR DETERMINATION OF THE ALLOCATION OF ITS RESOURCES.
Federal Tax Return, Form 1040*
Please upload a copy of your most recent Federal Tax Return, Form 1040
Accepted file types: jpg, pdf, Max. file size: 100 MB.
Cost of program
Any other financial assistance you will be receiving for this program
Amount you are requesting in scholarship funding

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Parent / Guardian Agreement
Parent / Guardian Agreement*
All of the information stated in this application and all supplemental documentation, to the best of my knowledge, is accurate and complete.
Parent / Guardian Signature*
First Last
Date*
MM slash DD slash YYYY
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