NPIFFNewStudentApplicationForm

Application for Special Musical Opportunity Subsidy - Norwin Play It Forward Fund
Contact Information
Student Name *
Grade *
Street Address *
City State Zip *
Instrument Played *
School *
Program Director *
Father/Guardian Name *
Mother/Guardian Name *
Student lives with: *

Mother Father Mother and Father Guardian
Parent/Guardian Email Address *
Parent/Guardian Phone Number *
Event Information
Type of Event *

Music Camp Special Event
Name of Event/Camp *
Date of Event *
Full Cost to Atttend *
Student Essays (To be completed by the Student)
Why would you like to attend this special educational opportunity? Please share your story. *
What kind of experience can this event provide you? *
How will you share what you learn with others? *
May the Norwin Play It Forward Fund use your story to encourage others to participate and/or to promote the program to funding agencies? (Your answer does not affect eligibility.) *

Yes No
Norwin Play It Forward Fund Policies
Agreement and Signature
By submitting this application, we affirm that the facts set forth in it are true and complete. Norwin Play It Forward Fund and it's funding committee reserves the right to validate information contained within, including, but not limited to, federal free/reduced lunch status. Falsification of information is considered fraud, and will automatically deny, cease or suspend future funding. The instructor's evaluation of the student's progress will be on-going, and continued participation is contingent upon successful instructor evaluations relative to progress and adherence to established guidelines and policies as specified in this document.
1) Students must maintain at least a "C" (2.0 on a 4.0 QPA) grade average to continue to qualify for funding.

2) If applicable, the Student Fair Share Account(s) must be up-to-date to qualify for funding - unless the family has participated in the hardship process with the Norwin High School Director of Bands

3) It is the policy of the Norwin Play It Forward Fund to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, or age (as long as student is enrolled in grades 5 through 12) or disability. All decisions are made by the appropriate Band/Orchestra Director, applicable Norwin Music Department Staff, and the Application Evaluation Committee, and not the Officers of the Norwin Play It Forward Fund, Inc.

4) It is understood that funds are only available as the Norwin Play It Forward Fund Inc. has funds available to distribute, and approval for participation in special musical opportunities are limited to one per year per student.

5) Funds from the Norwin Play It Forward Fund Inc. are disbursed directly to event coordinators or camps as approved by the appropriate Band/Orchestra Director, and not to the student nor family.

6) Students who receive approval for subsidized special musical opportunities are expected to submit a "Thank You" letter to the Application Evaluation Committee. Please mail correspondence to: The Norwin Play It Forward Fund, Inc., 531 Cedar Glenn Drive, North Huntingdon, PA 15642 ATTN: Application Evaluation Committee.
Student Name *
Student Signature (forward slash before and after typed name) *
Parent/Guardian Name *
Parent/Guardian Signature (forward slash before and after typed name) *
Date and time completed

Month Day Year Hour Minutes AM/PM Option
Enter the message as it's shown *
After the student and parent/guardian have completed their part of the application, please click the "Submit" button below. It is understood that once the "Submit" button has been clicked, the application can no longer be edited, and it will be considered by the Application Evaluation Committee and the appropriate Band/Orchestra Director.
DETERMINATION - FOR OFFICE USE ONLY
MUSIC DIRECTOR EVALUATION: DATE: ________________________________

Student Attitude:

Why should this student be considered?

RECOMMENDATION FOR APPROVAL (Circle one): Yes No

_ Instructor's Signature: ______________________________________________________________
DIRECTOR OF BANDS EVALUATION: DATE: ________________________________

_ Student Grades Reviewed _ FAIR SHARE UP TO DATE

_ Not eligible at this time: Reason: _______________________________________________________

_ Recommended amount of subsidy: ___________

_ DATE REVIEWED: __________________________________

Comments:

Upon completion, please scan this form and send to norwinpiff@gmail.com for Committee Review. Committee meets once per month to review applications.
Should be Empty:

Application for Special Musical Opportunity Subsidy - Norwin Play It Forward Fund

Student Essays (To be completed by the Student)

Norwin Play It Forward Fund Policies

Agreement and Signature

DETERMINATION - FOR OFFICE USE ONLY