Date :

Name :

Address :

Phone :

Fax :

E-mail :

Name and address of school :

An optional photo may be included :

NOTE: IRS regulations require that Gift Scholarship checks be made payable to you AND your school. Please enclose or forward to us proof of acceptance or enrollment.

Academic year :

Brief history of your interest in Sacred Harp/shape-note singing (you may attach additional sheets if needed) :

Brief statement of financial need:

Complete and return to:

Joe Beasley Memorial Foundation, Inc.
ATTN: Sarah Beasley Smith, Secretary
431 Woodland Road
Bessemer, Alabama 35020

Or Fax to: (205) 428-6995