Tuition Assistance Application
Student Name
*
First Name
Last Name
Instrument or Class
*
Student Birth Date
*
-
Month
-
Day
Year
Date
Teacher Placement
*
Have the student been placed with a tecacher
Lesson Day and Time Placement
*
Please type the lesson day and time that the student has been given
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Caregiver Contact Information
Adult Students Please Fill in Your Information
Caregiver #1 Contact Info:
*
First Name
Last Name
Caregiver #2 Contact Info:
First Name
Last Name
Caregiver #1 Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Caregiver #2 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Caregiver #1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Caregiver #2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Caregiver #1 Email
*
example@example.com
Caregiver #2 Email
example@example.com
Caregiver #1 Employer, Employer Address, and Position:
*
Employer: Job Title: Address:
Caregiver #2 Employer, Employer Address, and Position:
Employer: Job Title: Address:
Depended Children
Rows
Child's Name
Child's Age
Child #1
Child #2
Child #3
Child #4
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Caregiver/Guardian/Adult Student Financials:
The information below determines if your application meets our criteria for tuition assitance. It is essential your information is accurate. Your thoroughness and honesty is essential in order to ensure the best use of limited tuition assistance funds. Your information will be kept in the strictest confidence.
Monthly Income Calculator:
*
Rows
Monthly Income
Parent/Guardian 1 Salary
Parent/Guardian 2 Salary
Bonuses/Commissions
Dividends/Interest
Real Estate
Trust
Alimony
Child Support
Social Security
ADC
Cash/CDs
Securities
Other
Total Monthly Income:
Monthly Fixed Costs
*
Rows
Monthly Cost
Mortgage Payment
Rent
Car Payment
Other
Monthly Liabilities
Rows
Liability (Example: Loans, Insurance, Credit Cards)
Monthly Cost
1
2
3
4
Total Monthly Fixed Costs/Liabilities
Total NET Income
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Personal Narrative
Please clearly state any extenuating financial circumstances. Please include information about why music lessons are a priority in the students life. This will provide the Tuition Assistance Committee with important information needed to determine award amounts. Only application that include narratives will be considered for tuition assistance. We may ask for additional information to complete the narrative portion of the application.
This narrative is an important part of the application process, please take time to tell your story.
Please type or paste your narrative below:
*
0/500
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Name of individual completing this form:
First Name
Last Name
Please Sign:
*
Submit
Should be Empty: