Music Together Financial Assistance Application

MT with CCSA Financial Assistance Online Application
Preferred Class Day/Time Location*
Day of the Week / Time / Location
Child #1 Name and Age*
Name & Age of child(ren)
Child #2 Name and Age
Name & Age of child(ren)
Child #3 Name and Age
Name & Age of child(ren)
Parent #1 Name*

First NameLast Name
Parent #2 Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
# in Household*
# of Dependents in Household*
Years at this Address*
Parent #1 Occupation*
Parent #1 Annual Income ($)*
Parent #2 Occupation*
Parent #2 Annual Income ($)*
Other Income Source(s)
Other Income ($)
Briefly state your need for assistance*
Please attach copies of your:

(a) most recent IRS Form 1040 (first page only)

OR

(b) most recent W-2 Wage statement(s) and/or 1099(s).
Most recent IRS Form 1040

Upload a File

Cancelof
Most recent W-2 Wage Statement #1

Upload a File

Cancelof
Most recent W-2 Wage Statement #2 (if applicable)

Upload a File

Cancelof
Please read each item below and enter your initials in the box to signify your agreement.
FINANCIAL RESPONSIBILITY - I understand that I will be financially responsible for my family's total registration cost minus any potential Financial Assistance awarded.
Enter initials here*
CANCELLATION PENALTY - I have read and understand the Cancellation Policy outlined on the Music Together with CCSA website. I further understand that, if I withdrawl my family from participation in Music Together with CCSA, any Financial Assistance awarded to my family will be returned to the Organization and will not be considered as part of the amount on account for purposes of refund calculation.
Enter initials here*
Please sign the application. Typing your name in the fields below indicates an electronic signature.
I understand and agree to the terms outlined above.*

First NameLast Name
Date of Submission*

MonthDayYearHourMinutesAM/PM Option
Number of Previous Music Together Semesters
Which Music Together Session are you applying for?*

Fall Music Together (Sept-Nov)Winter Music Together (Jan-Mar)Spring Music Together (Apr-June)Summer Music Together (July-August)Summer Pop-up ClassJingle Jam Pop-up Class
Should be Empty:

MT with CCSA Financial Assistance Online Application