Student Name *

Which program are you applying for? *

Date of Birth *

Parent/Guardian Name *

Relation to Student *

Mailing Address *

City, State *

Zip Code *

Primary Phone *

Secondary Phone *

Email Address *

How did you hear about our programs? *

Which instrument does your student want to play? *

How much can you pay towards your student's tuition? A full camp tuition is $320 and a full Rock Block tuition is $160. *

Is your student a recipient of the free and/or reduced lunch program at school? *

Are you a single-income family? *

I hereby certify to the best of my ability that all information on this application is valid and true. *

Which scholarship are you applying for? *

The Ain't Afraid Scholarship honors the talent and bravery of our longest camper-turned-volunteer Jessi Zazu. Through her musical projects from Those Darlins to her upcoming solo record, she was an incredible musician and activist who faced cancer head-on with positivity and bravery. She's got a mystic mind, fast fingers, and the biggest heart of all. Has music ever helped you through a hard time and inspired you to face your fears? For this scholarship, tell us how making or listening to music helps you tackle challenges head-on. (Southern Girls Rock Camp only, either location) *

The Kelley Anderson Gear Scholarship: Kelley Anderson, co-founder of Southern Girls Rock Camp and YEAH!, is an amazing musician who is passionate about empowering youth to understand and use gear and technology of all types to express themselves. For this scholarship, tell us about how you currently use or want to use technology to express yourself. *

The Courtney Vickers Education Scholarship: Courtney Vickers, co-founder of Southern Girls Rock Camp and YEAH!, is an amazing teacher who is passionate about empowering youth through education in schools. For this scholarship, tell us about how a teacher has opened a door for you or helped you express yourself. *

The Anna Fitzgerald Community Scholarship: Anna Fitzgerald, co-founder of Southern Girls Rock Camp and YEAH!, is an amazing volunteer and community engagement expert who is passionate about empowering youth through music and giving back to their communities. Living as a positive leader and example for others is a huge part of rock camp, as big as learning more about how to play an instrument! For this scholarship, tell us about how you use or want to use your creativity to help strengthen the community in which you live. *

Gruhn Guitars Scholarship: Unlike many other objects and possessions, a player often forms a very special bond with the instrument they play. While Maybelle Carter used her 1928 Gibson L-5 throughout her career and Willie Nelson has played his 1968 Martin N-20 classical guitar since he purchased it new, other musicians trade or collect many instruments to create unique sounds, inspire their songwriting, or to explore new musical styles. For this scholarship, we’d like you to write a full page about your relationship with your guitar or bass and why the instrument is special to you as a player. As an alternative, if you don’t yet own the instrument (or instruments) of your dreams, tell us what it would be and why it would inspire you to play music for many years to come. *

Why are you applying for a scholarship? How do you believe your student will benefit from the experience of attending this program? *