Name: Holter Museum of Art
Address: 12 E. Lawrence St., Helena, MT, 59601, US
Telephone: (406) 442-6400

Payment Amount*

Enter the amount of your payment. If you have questions regarding the amount, contact Holter Museum Education staff.
Class, workshop, or program payment is being completed for.*
Contact Email*
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Total
$0.00
Credit Card
Card Details
Cardholder Name

Student Name*
If applying for more than one participant, fill out a new application for each participant.
First Last
Student Age and Grade*
Requested Workshop Title, Date of Session/s, Tuition*
Percent of Tuition requested for Scholarship (check one)*
- 25%
- 50%
- 75%
- Full scholarship is available in extenuating circumstances.
Please use this space to write a brief statement of interest and description of need including any additional information we should know.*
Parent-Guardian Name*
First Last
Email*
Phone*

Scholarship Application

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