APPLICATION

HIGH NOTES MUSIC PROGRAM

Application form
This initial application is for 10 sessions after which you will have to reapply (with another form) Application and reapplication doesn't guarantee acceptance as we rely on funding from various sources. Please fill in the application with as much detail as possible to help us make a well informed decision.

FYI, the value of the 10 weeks lessons are approximately $500.
Full Name of applicant

First NameLast Name
Current Age
Street Address
Unit or apartment number (if applicable)
City, Province, Postal Code
E-mail
Phone Number: Best one to contact you

Area CodePhone Number
Have you been touched by mental illness?
Main reason for applying
Choose all that apply to you:

Other
Preferred Instrument/class:
PLEASE INDICATE YOUR FIRST CHOICE CLASS:
Do you want an in-person lesson?
Please answer the following to help us determine the best teacher/studio for you
Please tell us your closest major intersection, city and province
What is your availability (for a 30 minute music lesson)?
Additional information to support your application to the program:
Optional Reference

Could be a mental health care professional, social worker or anyone who can vouch that participating will benefit you.
Reference #1 Name, Phone, Email & Relationship to you
SELECT ALL TO BE CONSIDERED FOR THE PROGRAM
Date

MonthDayYear
Date
HOW DID YOU HEAR ABOUT THE HIGH NOTES MUSIC PROGRAM?

Other
Thank you for applying to High Notes Music Program

We are so excited to meet you and will be in touch as soon as possible.
ADMIN ONLY ASSIGNED TEACHER
FINAL LESSON TIME
DATE SURVEY SENT
ADMIN ONLY:
DATE 2nd SURVEY SENT
DATE Reapplication form sent
Should be Empty:

HIGH NOTES MUSIC PROGRAM

Optional Reference

Thank you for applying to High Notes Music Program