NPIFFNewStudentApplicationForm

Application for Subsidized Music Lessons - Norwin Play It Forward Fund - RENEWAL STUDENT
Contact Information
Student Name*
Grade*
Street Address*
City State Zip*
Instrument Played*
School*
Program Director*
Father/Guardian Name*
Mother/Guardian Name*
Student lives with:*

MotherFatherMother and FatherGuardian
Parent/Guardian Email Address*
Parent/Guardian Phone Number*
Student Lesson Information
Current Instructor:*
Are you planning to continue lessons with this instructor?*

YesNo
If you answered "No" to the above question, please enter the name of the new instructor here.
Where do you take lessons?*
If Music School or Studio, specify name and location
Length of Lesson (You must select a length of lesson that instructor you've selected offers. Changes to length of lesson will require a new application since instructor rates can change with length of lesson):*
Frequency of lesson*
Instructor charge per lesson*
NPIFF current subsidy amount per lesson*
Current family payment amount per lesson - this amount and the above amount must total the "Instructor charge per lesson"*
In order to qualify for NPIFF funding, lessons must be taken with a qualified and approved instructor, either with an established member of the Norwin Music staff, or additional instructors as approved by application and selection by the Norwin High School Director of Bands. All instructors 18 years of age or over must have necessary clearances and background checks/documentation, and be willing to provide them to NPIFF. Parents/guardians must also perform their due diligence relative to instructor selection as it pertains to contact information, lesson rate and length.
Student Essay (To be completed by the Student)
In your own words, tell us why you should qualify for subsidized music lessons. If it's easier to write an essay in a Word Document, please note that in the box and and upload below. We encourage you to tell your story!*
Student Motivation Essay

Upload a File

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In your own words, tell us how you HAVE "Played It Forward" if you received subsidized music lessons. If it's easier to write an essay in a Word document, please note that in the box and upload below. Again, we encourage you to tell your story!*
Student Intention Essay

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Parent/Guardian Financial Need Assessment (To be completed by the Parent/Guardian)
The following describes our family's financial need status:*

My family participates in the National School Free and Reduced Lunch ProgramWe have financial need as explained in the next section
FINANCIAL NEED EXPLANATION - must be completed if second option above is chosen. Please be as complete as possible. Simple statements, such as, "We can't afford it" or "It's not in our budget" are not acceptable. There needs to be a story to offer the review committe why subsidy should be approved. If you wish to complete the essay via a Word document, please note that in the box and upload the docuement below.
Need Assessment Essay Upload

Upload a File

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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.)*

YesNo
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. Both student and parent/guardian understand that if the student is approved to receive subsidized music lessons, the student will make every effort to attend scheduled lessons; that the student will adhere to the practice schedule as assigned by the instructor, and that the student will continue to participate in the Norwin Band and/or Orchestra program. 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 subsidized lessons

2) If applicable, the Student Fair Share Account(s) must be up-to-date to qualify for subsidized lessons - 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 Norwin Director of Bands, applicable Norwin Music Department Staff, and the Application Evaluation Committee, and not the Officers of the Norwin Play It Forward Fund, Inc.

4) Students chosen to receive subsidized lessons must reapply annually, and any student not selected may reapply at each semester.

5) Any students chosen to receive subsidized lessons may lose their privilege without notice by failing to adhere to the policies and guidelines as agreed to by signature of this document.

6) It is understood that funds are only available as the Norwin Play It Forward Fund Inc. has funds available to distribute, and participation may be limited to one child per family.

7) Funds from the Norwin Play It Forward Fund Inc. are disbursed directly to instructors as approved by the Norwin High School Director of Bands or designee, and not to the student nor family.

8) Students who receive approval for subsidized music lessons or music camp grants 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

MonthDayYearHourMinutesAM/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 COMMITTEE USE ONLY
_ Student Grades Reviewed                                        _ FAIR SHARE UP TO DATE

_ Subsidy Approved at $ ______ per lesson              _ Length of Lesson Approved: _____ per ______

_ Reapplication due _____________________

_ Not eligible at this time: Reason: _______________________________________________________

_ DATE REVIEWED: __________________________________

* Note: Student and teacher must stay with approved lesson subsidy, length and frequency.

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Application for Subsidized Music Lessons - Norwin Play It Forward Fund - RENEWAL STUDENT

Student Essay (To be completed by the Student)

Parent/Guardian Financial Need Assessment (To be completed by the Parent/Guardian)

Norwin Play It Forward Fund Policies

Agreement and Signature

DETERMINATION - FOR COMMITTEE USE ONLY