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APPLICATION FOR ART LESSONS, MUSIC LESSONS & INSTRUMENT REQUESTS
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Student Information
Name
(required)
Date of Birth (YYYY-MM-DD)
(required)
School Name
(required)
Grade
(required)
Select one option
1
2
3
4
5
6
7
8
9
10
11
12
Parent/Guardian Information
Name
(required)
Street Address
(required)
City
(required)
State
(required)
ZIP Code
(required)
Email
(required)
Phone
(required)
Do you have a financial hardship?
(required)
Yes
No
If yes, please explain.
Is it okay to post a photo of your child on the foundation’s website or social media?
Yes
No
What Are You Applying For?
Choose all that apply
(required)
Art Lessons (please fill out Art Lessons section below)
Music Lessons (please fill out Music Lessons section below)
Instrument Request (please fill out Individuals Requesting an Instrument section below)
Art Lessons
Art medium
Have you ever taken private art lessons?
Yes
No
If yes, how many years?
Select one option
less than 1
1
2
3
4
5
more than 5
How would you benefit from private art lessons?
Days available (check all that apply)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Times available (check all that apply)
Mornings
Afternoons
Evenings
How soon can you begin lessons?
Music Lessons
Instrument
Have you ever taken private music lessons?
Yes
No
If yes, how many years?
Select one option
less than 1
1
2
3
4
5
more than 5
How would you benefit from private music lessons?
Days available (check all that apply)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Times available (check all that apply)
Mornings
Afternoons
Evenings
How soon can you begin lessons?
Individuals Requesting an Instrument
What instrument are you requesting?
Have you ever received lessons or some other form of training?
Yes
No
If yes, how many years?
Select one option
less than 1
1
2
3
4
5
more than 5
Do you already have access to an instrument?
Yes
No
If yes, do you own or rent?
Select one option
own
rent
How would you benefit from receiving an instrument?
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