Live On Loud - The Taylor Davis Foundation, Inc.
Instrument Request/Nomination Form
Section 1: Nominee Information
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Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age/Grade in School
*
Address (City and State Required)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
School Attended (if applicable)
Email
*
example@example.com
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Section 2: Nominator Information
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Name
*
First Name
Last Name
Relationship to Nominee
Please Select
Parent/Guardian
Teacher
Coach
Family Member
Neighbor
Friend
Other
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email Address
*
example@example.com
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Section 3: Musical Background
Does the nominee currently play an instrument?
Please Select
Yes
No
If yes, which instrument(s) and how long have they played?
Do they currently own an instrument, or use a borrowed one/school one?
Please Select
Owns one
Uses borrowed one/school one
Has no access to one
Do they need lessons?
Please Select
Yes, needs lessons from scratch
Yes, wants to continue lessons
No, self-taught and doesn't need lessons
Has access to lessons already
Which instrument are they hoping to receive? Guitar(acoustic), Guitar (electric), Other (please specify)
*
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Section 4: Need and Access
Would financial barriers otherwise prevent this person from having access to an instrument or lessons? Please explain.
*
Does their school or community currently offer music programs? If not, please describe.
*
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Section 5: Nomination Story
Why are you nominating this person?
*
How would receiving an instrument from Live On Loud - The Taylor Davis Foundation, Inc. impact their life?
*
Describe their passion for music-what have you seen that shows this matters to them?
*
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Section 6: Wrap Up
How did you hear about this program?
*
Anything else we should know?
I give permission for Live On Loud - The Taylor Davis Foundation, Inc. to share this nomination and photos/videos of the recipient for promotional and social media purposes.
*
Yes
No
Does the recipient need a left or right handed instrument?
Left Handed
Right Handed
Don’t know
Submit
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