Master Music Scholarship Application
Student Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student's Current Grade Level:
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Date of Birth
*
-
Month
-
Day
Year
Date
Is the student a Foundation Black American? (This means they can trace their ancestry to 1870 US Census)
*
Yes
No
Instrument of Choice
*
Piano
Trumpet
Bass
Guitar
Drums
Saxophone
Flute
Other
Does student currently own or rent their instrument of choice?
*
Please Select
Own
Rent
Doesn't have an instrument
Is student in a music program at school?
Yes
No
Would student be willing to be featured as a Music Legacy Scholarship alumnus?
Yes
No
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Parental Information
Name of Parent
*
First Name
Last Name
Parent Email Address
*
example@example.com
Address of Parent (if not the same as student)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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I certify all information I have provided is true and correct to the best of my knowledge.
Parent Signature
Date Signed by Applicant
-
Month
-
Day
Year
Date
Submit
Should be Empty: