v o l u m e 1 3 , i s s u e 6 f e b r u a r y 7 , 2 0 1 …...v o l u m e 1 3 , i s s u e 6 f e b r...

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Happy February Mapleview Families! January was a crazy month at Mapleview, a month where the routine was not consistent. From MAP testing to conferences and weather issues, it was difficult for staff and students to get into a rhythm. I'm hoping from here on out it is much calmer and allows us to focus on taking care of student needs both socially/emotionally and academically. We still did have a lot to celebrate in January. Our winter MAP testing showed tremendous growth in student learning. That test allowed us a mid-year check in on student growth and learning and now students and staff have set goals for the end of year outcomes. Students, keep working hard at im- provement and growth! Please be sure to note the students rewarded in our Faces in the Crowd section. As I talked with teachers, it was very difficult to choose just a few students to reward this month as there are so many great students here at Mapleview. Those that received the nominations have gone above and beyond in their Kindness and caring. To all students, keep up the good work in being kind and caring! This week, teams of teachers met to dig deeper on how we can support student learning and problem solving. I appreciated the conversations and the focused discussions around working with all stu- dents. As you know, we are working on students understanding their current state of learning, identify- ing a gap or area of growth, developing strategies to close that gap, and then reflect on what they did and how it worked. We continue to experiment in those areas as we believe student ownership or learning and problem solving is the key to developing life-long learners. Finally, please note the letter included in this newsletter about Forward testing. Due to the timing of spring break this year we have decided to split the Math and ELA tests into two separate weeks rather than testing all in one week. Parents, please contact the school if your son or daughter will be missing any school the weeks of April 8, 22 or 29 due to vacation reasons. Forward testing must be completed by May 3 and we want to be sure we are able to test all students. Again, parents, thank you for all that you do to support student learning at Mapleview. Our focus is to make sure that your children have a safe place to learn and grow. Sincerely, Jason Nate Principal Mapleview Intermediate School - Where Students Grow! Message From the Principal Mapleview Intermediate FEBRUARY 7, 2019 VOLUME 13, ISSUE 6 The Kimberly Area School District does not discrimi- nate on the basis of race, color, reli- gion, naonal origin, ancestry, creed, pregnancy, marital status, parental status, sexual orientaon, sex, (including transgender sta- tus, change of sex or gender iden- ty), or physical, mental, emoonal, or learning disabil- ity ("Protected Classes") in any of its student pro- grams and acvi- es.

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Page 1: V O L U M E 1 3 , I S S U E 6 F E B R U A R Y 7 , 2 0 1 …...V O L U M E 1 3 , I S S U E 6 F E B R U A R Y 7 , 2 0 1 9 The Kimberly Area School District does not discrimi-nate on

Happy February Mapleview Families!

January was a crazy month at Mapleview, a month where the routine was not consistent. From MAP

testing to conferences and weather issues, it was difficult for staff and students to get into a rhythm. I'm

hoping from here on out it is much calmer and allows us to focus on taking care of student needs both

socially/emotionally and academically.

We still did have a lot to celebrate in January. Our winter MAP testing showed tremendous growth in

student learning. That test allowed us a mid-year check in on student growth and learning and now

students and staff have set goals for the end of year outcomes. Students, keep working hard at im-

provement and growth!

Please be sure to note the students rewarded in our Faces in the Crowd section. As I talked with

teachers, it was very difficult to choose just a few students to reward this month as there are so many

great students here at Mapleview. Those that received the nominations have gone above and beyond in

their Kindness and caring. To all students, keep up the good work in being kind and caring!

This week, teams of teachers met to dig deeper on how we can support student learning and problem

solving. I appreciated the conversations and the focused discussions around working with all stu-

dents. As you know, we are working on students understanding their current state of learning, identify-

ing a gap or area of growth, developing strategies to close that gap, and then reflect on what they did

and how it worked. We continue to experiment in those areas as we believe student ownership or

learning and problem solving is the key to developing life-long learners.

Finally, please note the letter included in this newsletter about Forward testing. Due to the timing of

spring break this year we have decided to split the Math and ELA tests into two separate weeks rather

than testing all in one week. Parents, please contact the school if your son or daughter will be missing

any school the weeks of April 8, 22 or 29 due to vacation reasons. Forward testing must be completed

by May 3 and we want to be sure we are able to test all students.

Again, parents, thank you for all that you do to support student learning at Mapleview. Our focus is to

make sure that your children have a safe place to learn and grow.

Sincerely,

Jason Nate

Principal

Mapleview Intermediate School - Where Students Grow!

Message From the Principal

Mapleview Intermediate F E B R U A R Y 7 , 2 0 1 9 V O L U M E 1 3 , I S S U E 6

The Kimberly Area

School District

does not discrimi-

nate on the basis

of race, color, reli-

gion, national

origin, ancestry,

creed, pregnancy,

marital status,

parental status,

sexual orientation,

sex, (including

transgender sta-

tus, change of sex

or gender identi-

ty), or physical,

mental, emotional,

or learning disabil-

ity ("Protected

Classes") in any of

its student pro-

grams and activi-

ties.

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Please do not drop students off where they need to cross traffic on Maple Street or

Kimberly Avenue. Also, please have students get out of the car as soon as your vehi-

cle reaches the sidewalk in the front of the building. This allows 4-5 students to be

dropped off at once to keep traffic flowing.

When parking on the street to pick up your child, please be considerate of our

Mapleview neighbors. We ask that people do not block driveways when parked on

the street. Thank you for your cooperation.

M A P L E V I E W I N T E R M E D I A T E

SAFETY UPDATE

Spelling Bee All students participated in individual classroom spelling bee competitions. The following

students participated in the school’s final competition:

Sergio Aguirre, Michael Criter, Kara Fritsch, Maddie Groshek, Max Heiling, Gwen

Hughes, Jack Kramer, Jackson Matz, Maddi Mohr, Madelyn Mayo, Colin Miller, Madeline

Oatman, Aiden Pipersburg, Colton Pozniak, Tyler Schmidt, Jed Strickland, Jack Tiedman,

and Layla Tremble,

Congratulations to Colton Pozniak our school

finalist and runner up Jackson Matz. Both students

will be moving on to the Regional Spelling Bee at Lawrence University.

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P A G E 3

Winter Walk to School Day It was a great morning for our Winter Walk to School Day on Wednesday, February 6. Mr. Nate,

Mrs. Jochimsen and Officer Stahmann met students at Roosevelt Park at 7:00 a.m. and finished the

walk to school together. Officer Stahmann shared some important pointers for students regarding

safety while walking and biking. It was a chilly morning with a fresh blanket of snow on the sidewalks,

but it was a lot of fun to start our day with fresh air and conversation. The East Central Wisconsin

Safe Routes to School Program provided us with some awesome prizes! All students received long-

sleeve shirts, fleece blankets, hats, gloves or Subway gift cards. Keep an eye out for our Bike to School

day this spring!

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Thank you

Intramurals Basketball intramurals will be wrapping up next week with games against Wood-

land. On Wednesday, February 13 the boys will be traveling to Woodland. The girls will

play at Woodland on Thursday, February 14. As the note that came home stated, we will be

playing new games every 10 minutes beginning at 3:30. The team with the best record from

each school will meet in the championship game at 4:40. After signing out with a Mapleview

coach, players can ride home with their parents after all of the games are done. The bus

will be back to Mapleview at 5:15 for those who will be picking up their child there. Parents

are encouraged to attend.

Good luck to our Battle of the Books team when they compete online with teams

around the state! The final battle will happen during lunch/recess on February 25.

Chess & Cribbage Club, Boys Volleyball, 5th Grade Art Club and Coding Club

will begin in the coming weeks. We are excited by the large number of students who

choose to be involved in our intramural activities! Unfortunately, students have to make

choices between club/activities sometimes, due to the available space and supervi-

sion. Students will find out on February 12 the final rosters for each club.

The K-Kids Secret Service wishes to thank

everyone for making this year's bake sale

at conferences a huge success! The money

raised becomes our "operating budget"

and will be used solely for service projects

over the next year. A special thanks to K-

Kids Secret Service members (and parents)

for donating their talents in preparing the

delicious dishes!!!

M A P L E V I E W I N T E R M E D I A T E

Thanks to everyone who

came to our Book Fair and to

all who helped make it a

great success, a big thank

you!

Keep on reading, and we’ll

see you at our next Fair!

Emergency Medication Please be aware that emergency medications that are provided for use during the

school day will not be accessible after school hours. Parents and students plan

ahead to have emergency medication available during after school activities such as

clubs and sports. If an emergency arises and a student does not have their emergen-

cy medication available, 911 will be called.

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Brad Demmin, counselor from JR Gerritts, will be meeting with 6th grade students at Mapleview during the

week of March 4 to discuss course selection for next year.

Students will be given info on the different course offering as well as how to register for classes

After the presentation, students will receive a course selection form upon which they will make

schedule choices. Parents are asked to review and sign off on the choices Students need to return

this form by March 7.

On March 8, students who have turned in the selection forms will complete course registration in

their homerooms.

Keep in mind that students with exceptional educational needs may have other support or enrichment classes

that are not listed in the required courses. You will not select those classes yet. If needed, school staff will help

you register for those classes at the appropriate time.

If you’d like more information before these presentations, the online course booklet for 7th grade can be found

at goo.gl/FVqYzs. A video overview of JRG’s schedule can be viewed at https://goo.gl/iGDvCb. Even though it is

from a previous year, the schedule remains the same.

If you have any questions ahead of time, please feel free to contact Rob DeLain, Assistant Principal of JR Ger-

ritts at 788.7905 or [email protected].

6th Grade JR Gerritts Registration Information

Sixth graders will begin their academic unit of guidance in February. In this unit, students discuss goal setting,

how to prioritize responsibilities and the importance of soft skills (also referred to as employability skills, learning

habits or skills for success, to name a few). Being a member of the workforce is a few years away for our 6th

graders, but the skills that are needed to be a productive member of that workforce can be developed now. As

we continue to support our students’ Academic and Career Planning (ACP) development in guidance, goals stu-

dents create will be entered into Career Cruising. Towards the end of the month, students will be emailing par-

ents about these goals. When you receive this email, ask your child to show you what goals they are working on.

It’s National School Counselor Week! Yay Counselors!!! To celebrate, you will find a quiz attached about the

counseling program at Mapleview and in the district. Students who turn this quiz into Mrs. Dietzler over the next

few days will get to pick out a treat! I absolutely love being the counselor at Mapleview! Thank you for your sup-

port of the counseling program and for your partnership in providing the best for ALL our students!!

Counselor Corner with Mrs. Dietzler

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Bus Reminder

A note from Mr. Calmes:

If anyone has items that they would like to donate for use in my art classes,

please bring them into the office. If you are not sure if I will use particular

items, please contact me. I am always looking for people to donate items

from home or work. Thank you!

M A P L E V I E W I N T E R M E D I A T E

Art Supplies

Per Bus Policy, students who are NOT bus eligible are not allowed

to ride the bus to or from school with a bus eligible student.

A reminder to parents

that all attendance must go

through the Main Office in

advance. Please send a note

with your child, call the

office at 788-7910 to speak

to a secretary, or leave a

message on our attendance

line. The office will then

update your student’s at-

tendance in Infinite Cam-

pus. You may inform teach-

ers if you so choose, how-

ever, the Main Office

should be the initial contact

to avoid any unexcused

absences. You are able to

leave a message at any time

outside of our normal of-

fice hours (3:15 PM-7:00

AM).

Wisconsin’s school com-

pulsory law requires stu-

dents miss no more than

ten (10) days per school

year. Once a student has

missed ten or more days of

school a doctor’s note may

be required to excuse the

absence. Students who visit

the doctor due to an ex-

tended illness in advance of

the ten days are also en-

couraged to send a doc-

tor’s note to the Main Of-

fice excusing the ab-

sence. Absences excused

by a medical professional

generally do not count to-

ward a student’s ten day

maximum. If you have

questions regarding our

attendance policy or a

unique circumstance,

please contact Valerie

Schroeder, the Mapleview

Intermediate attendance

secretary.

School Attendance

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PBIS February KINDNESS Update

The Mapleview bulletin boards, morning announcements, staff shirts, ARK presen-tations and conversations in our classrooms continue to emphasize Kindness.

To jump start 2019 with kindness on our minds and in our messages to our stu-dents, we played a school-wide game of Wheel of Fortune - Kindness version! Hopefully many of you were able to study and solve the phrases on the bulletin board at parent/teacher conferences.

Classes were given the opportunity on Monday video announcements to spin, guess a letter and earn ‘money’. Classes also earned spins with good hallway behavior and showing respect throughout the week. Mrs. Janssen’s class was the first to solve the 5th grade phrase, and Mrs. Dagenais' class was able to guess the phrase for 6th grade. They celebrated with class pizza parties this week.

These classroom games provide a chance for each homeroom to work as a team to achieve a common goal and to focus on important life skills like being kind. There was a lot of excitement and anticipation each week as more of each phrase was revealed!

5th grade -“Kindness is a Gift Everyone Can Afford to Give”

6th grade - “A Warm Smile is the Universal Language of Kindness"

‘Bob’ the Bobcat gives a thumbs up to the Wheel of Fortune bulletin boards in the hall-way! Bob visited each classroom during the ARK activity on January 25 and asked all students to reflect on what the phrases mean to them and how they can make an impact by being kind each day in our classrooms and hallways at Mapleview.

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In an effort to recognize students who are going above and beyond what is expected of them

at Mapleview Intermediate, “Faces in the Crowd” has been established. Once a month

students are nominated by their classroom or specials teachers and one student will be

chosen from each class throughout the school year.

February’s “Faces in the Crowd” are: Marisol Brown, nominated by Mrs. Hanes; Isaiah

Frederickson-Thomas, nominated by Mr. Nate; Emma Bodway, nominated by Mr. Voss; Cara

Sauter, nominated by Mr. Calmes; Teddi Hubert, nominated by Mrs. Schommer; Kendra

Schnese, nominated by Mrs. Dietzler; Corbin Hurrelbrink, nominated by Ms. Pohlman; and

Kierra Hostettler nominated by Mrs. Vanderloop

Corbin Hurrelbrink Kierra Hostettler

Faces in the Crowd

Kendra Schnese Teddi Hubert

Marisol Brown Isaiah Frederickson-Thomas

Emma Bodway Cara Sauter

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125 East Kimberly Ave Kimberly, WI 54136 920.788.7910 Fax: 920.788.7760

Mapleview Intermediate School

Jason Nate, Principal

Dear Mapleview Parent or Guardian, Wisconsin students in grades 3-8 and 10 will be participating in the Forward Exam again this spring. This assessment includes literacy, math, science and social studies, though not all subjects are tested in all grades. Students in grades five and six at Mapleview will take the literacy and math assessments. Our schedule for testing at Mapleview this will be a little different than in year’s past. The schedule is as follows: Week of April 8

Date 4/8 4/9 4/10 4/11 4/12

Test Session and Estimated Length

ELA S1 TDA Writing Prompt (40 min)

ELA S2 Writing/Lang (20 min.)

ELA S3 Listening (20 min.)

ELA S4 Reading (50 min)

Week of April 22

Date 4/22 4/23 4/24 4/25 4/26

Test Session and Estimated Length

Math S1 5th (45 min) 6th (45 min)

Math S2 5th (45 min) 6th (60 min)

Please make every attempt not to schedule appointments on these testing days. Coming to school on time, rested and with a good breakfast will help students be as successful as possible. Thank you in advance for your help in preparing students for our exam. The results from state testing, along with local measures such as report cards, classroom assessments, and teacher feedback, provide meaningful information about the students’ academic achievement to parents, students, teachers and the school district. Additional information about the Forward Exam can be found in the accompanying brochure. If you have questions about the Forward Exam, please contact me. Sincerely, Jason Nate

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What is the Wisconsin Forward Exam? The Wisconsin Forward Exam is designed to gauge how well students are doing in relation to the Wisconsin Academic Standards. These standards outline what students should know and be able to do in order to be college and career ready. The Forward Exam is administered online in the spring of each school year at: grades 3-8 in English language arts (ELA)

and mathematics, grades 4 and 8 in science and, grades 4, 8, and 10 in social studies.

The Forward Exam includes several question types: Multiple‐Choice (MC)

Question that has four answer choices, including three distractors and one correct answer.

Enhanced Selected Response (ESR) Question which may contain combinations of MC, short‐answer, and technology‐enhanced.

Evidence‐Based Selected Response (EBSR) Question which has two parts. The student answers Part A, then provides evidence in Part B to support answer in Part A.

Text‐Dependent Analysis (TDA) Question used on the ELA test. The TDA is a text‐based analysis, based on a passage that read by the student during the assessment. Students must draw on basic writing skills while inferring and synthesizing information from the passage in order to develop a comprehensive, holistic essay response. Students have up to 5000 characters to formulate their response.

Technology‐Enhanced (TE) TE questions allow for a more engaging, interactive assessment. A wide variety of TE questions are present on the Forward Exam including:

Clock Input Angle Draw Short Input Bar Graph Number Line

Coordinate Graph Line Plot List Drag and Drop Drop‐Down List Pictograph using Drag and Paste Circle Graph Matching Highlighting Text

Accommodations and supports for students with disabilities and/or English language learners are built into the system so that the progress of students can be accurately measured.

What does this mean for my child? The Forward Exam is a summative assessment that gauges your child’s achievement in the content areas tested compared to other students in the state. Along with local measures such as report cards, school-wide assessments, and other information about your child’s progress in school, the results from the Forward Exam provide insight into how well your child is doing on a broad measure of achievement.

What are the test times? The estimated time for test administration in each grade is approximately: 2 hours and 20 minutes for ELA, 1 hour and 45 minutes for Mathematics, 1 hour and 40 minutes for Science, and 1 hour and 30 minutes for Social Studies. These are estimated times, for the purpose of scheduling, as the Forward Exam is not a timed test.

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February 4-8, 2019

It’s National School Counselor’s Week! Quiz yourself on what YOU know about Mrs. Dietzler as

well as our school and district’s school counseling program! Students who bring me their

completed quiz will get to pick a treat if done by Monday, February 11!

1. This is Mrs. Dietzler’s ____________ year as a school counselor in Kimberly.

a. 8th c. 14th

b. 10th d. 16th

2. What is The Secret Service Club all about?

a. It is an after school club that participates in community service activities.

b. A student group who promotes safety in the hallways before and after school.

c. It is Mapleview’s version of Student Council.

3. Mapleview’s Clothes Locker is…

a. A place to put all your belongings in each day.

b . A place for people to pick out clothing, shoes and coats at no charge.

c. A small group Mrs. Dietzler leads that enjoys shopping.

d. Also known as “the coat rack area.”

4. What of the following is NOT a unit of guidance used for classroom guidance?

a. Academic Unit

b. Career Unit

c. Social/Emotional Unit

d. Conflict Resolution Unit

5. What is the name of Mrs. Dietzler’s lunch group?

a. Lunch Bunches c. Eat and Greet

b. Chomp & Chatter d. Lunch-n-Learn

6. What does ACP stand for?

a. Activity and Club Planning c. Academic & Career Portfolio

b. Academic & Career Planning d. None of the above

7. How often is classroom guidance?

a. Every week c. Once a month

b. Every other week d. 3 Units are spread out throughout the year

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8. Red Ribbon is a week in October that brings special focus to what?

a. art appreciation d. drug and alcohol awareness

b. bully awareness e. the four community values

c. support for military f. treating each other with respect

9. Every school in the district has a full time school counselor.

a. True b. False

10. Mrs. Dietzler

a. Is married & has 3 children d. All of the above

b. Went to school at Mapleview when it was JRG e. None of the above

c. Enjoys camping, walking, running and spending time with friends and family

11. What is the name of Mapleview’s counseling newsletter?

a. The Buzz c. Counselor’s Chatter

b. Counselor Corner d. The Scoop

12. The Secret Service Club participated in ALL of the following activities except what?

a. Leaf raking in the neighborhood

b. Caroling at a nursing home

c. Bake sale to raise money

d. Playing BINGO at nursing home

e. Tie and donate fleece blankets

f. Baking treats for a shelter

g. Feeding America

h. Secret Service did all of the above.

13. ACP components Mrs. Dietzler helps with include:

a. Helping students learn about and navigate the Career Cruising website.

b. Facilitating iChat groups for 6th graders

c. Guiding students through the Career Matchmaker

d. Classroom lessons about soft skills and setting SMART goals.

e. All of the above Scoring: 0-2: Oh no, this is not good! You better go on-line and re-read the past newsletters!

3-6: It’s a good start, be sure to watch for my next newsletter to catch up on the latest

counseling happenings!

7-10: You probably know more than Mr. Dietzler!

11-13: You are an avid reader of Counselor Corner! Excellent!

THANKS FOR SUPPORTING THE COUSELING PROGRAM AT MAPLEVIEW!

I APPRECIATE YOUR TRUST! You may reach me at 788-7910 or email at [email protected]

Answers: 1. C 2. A 3. B 4. D 5. B 6. B 7. D 8. D 9. A 10. D 11. B 12. H 13. E

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Les and Dar Stumpf Youth Arts Scholarship

Les and Dar Stumpf combined their love of children and the community into a youth arts granting program to support area young people interested in music, drama, dance and visual arts. “We wanted to give young people the chance to use their unique talents to better themselves and continue a sharing and caring philosophy,” Les said. “We feel that God has given us great blessings and that we are on this earth to share, care and nurture wherever we can,” Dar said. “The Community Foundation has given us the tools to that end.” The Les and Dar Stumpf Youth Arts Scholarship program was established to provide, on the basis of need, discretionary financial assistance to children in kindergarten through high school to support participation in an art discipline (i.e. music, drama, dance, visual arts). Eligibility:

Students entering kindergarten through 12th grade, who reside in one of the following school districts: Appleton, Hortonville, Kaukauna, Kimberly, Little Chute, Menasha or Neenah and will be participating in an art discipline. Applicants must have a financial need to be considered.

Award Amount: Scholarship amounts will vary, not to exceed $500 per child per year.

Selection: Selection of recipients will be made by the Les and Dar Stumpf Youth Arts Scholarship Committee within the Community Foundation for the Fox Valley Region.

Payment Procedure:

Prior to the release of the scholarship payment, which will be made payable to and mailed to the provider of services, documentation of enrollment in the activity must be received by the Community Foundation for the Fox Valley Region, Inc. This should arrive in the form of a letter, invoice or billing statement from the sponsor of the activity.

Further Information: For more information regarding this and other scholarships or to obtain scholarship forms please visit the Community Foundation for the Fox Valley Region’s website at www.cffoxvalley.org/scholarships or contact us at [email protected] or 920-702-7619.

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Les and Dar Stumpf Youth Arts Scholarship Application

The Les and Dar Stumpf Youth Arts Scholarship program was established to provide financial assistance to families with a demonstrated financial need so that children (grades K-12), who reside in one of the following school districts: Appleton, Hortonville, Kaukauna, Kimberly, Little Chute, Menasha or Neenah, will have the opportunity to be enriched by an arts experience. Scholarships will be awarded at the discretion of the selection committee. Grant award checks are made payable to the provider of the service after an invoice or bill is received and approved by the Community Foundation for the Fox Valley Region. If a scholarship is awarded, it will only provide assistance for the program and provider listed on this application. Name of child: _______________________________________________________Age:______________________________

Number of dependent siblings living at home and their ages (including the applicant): _______________________________

Name of mother/guardian: ______________________________________________________________________________

Address: _________________________________________________City: ______________________Zip:_______________

Phone number: _____________________________________ Email: _____________________________________________

Mother/Guardian Employer: _______________________________________________ Check one: Full time Part time

Position/Duties:________________________________________________________________________________________

Monthly gross income:__________________________________________________________________________________

Name of Father/guardian: ______________________________________________________________________________

Address: _______________________________________________City: ________________________Zip:_______________

Phone number: _____________________________________ Email: _____________________________________________

Father/Guardian Employer: ________________________________________________ Check one: Full time Part time

Position/Duties:________________________________________________________________________________________

Monthly gross income:__________________________________________________________________________________

Student lives with (check one): Mother/Guardian Father/Guardian Both Joint Custody

Who is primary contact for this request? Mother Father

Does the student receive financial support from another person who does not live in the household? Yes No

If yes, please explain (dollar amount of support per month, and what kind of support, child support, etc): _____________________________________________________________________________________________________ _____________________________________________________________________________________________________

Unusual circumstances and expenses in the past year (please explain): _____________________________________________________________________________________________________ _____________________________________________________________________________________________________

Name of the program, activity, or type of lessons for which you are requesting financial assistance: _____________________________________________________________________________________________________

Name of program provider or instructor: ___________________________________________________________________

Address: ____________________________________________________City: _________________ Zip: ________________

Phone: ______________________________________________Email: __________________________________________

Starting and ending dates of the program (may not begin before May 15 and may not be used to reimburse previously incurred expenses.): ____________________________________________________________________________________

Has the applicant participated in this program previously? (if so, for how long?) ___________________________________

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Cost of Program, Activity, Lessons (please itemize): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Amount of Financial Assistance Requested ($500 maximum): ___________________________________________________ Has applicant received this scholarship in the past?________ If so, please indicate scholarship amount, activity, year(s) in which support was provided: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________

Have you applied for other funding for this activity? __________If so, where? _____________________________________

Did you receive funding? ____________________________________________Amount: ____________________________

What are your plans if you do not receive funding from the Stumpf Youth Arts Scholarship program? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please explain the circumstances that make it difficult for you to provide this opportunity for your child: (may attach additional sheet if needed)_____________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ My child is currently eligible for the following program(s):

_____ Free Lunch Program _____ Reduced Lunch Program

_____ Other: ___________________________________

**Please attach a letter of recommendation from a teacher or other adult who is familiar with the artistic or musical ability of the child. It is helpful to the committee if letters of recommendation are written by an arts instructor.

I understand that scholarship awards are made at the discretion of the selection committee and by submitting this application, I am not guaranteed funding. Late and incomplete applications will not be considered.

Parent Signature: ______________________________________________________________________________________ For questions, please contact the Community Foundation at (920) 702-7619 or [email protected]

Mail, fax or email completed form to: Community Foundation for the Fox Valley Region, Inc. 4455 W. Lawrence Street Appleton, WI 54914 Fax 920-830-1293 Email: [email protected] All applications are due at the Community Foundation Office by April 1

Late or incomplete applications will not be considered

All applicants will receive notification of the selection committee’s decision by mail.