APPLICATION for ASSISTANCE			2023-24
From the CHILDREN’S MUSIC FOUNDATION, INC.                                                                                                            (To be completed by a music teacher)
										Date______________
Student Data:
Name___________________________________________                      School____________________
									
Age_________		Grade_________		Date of Birth______/_______/________
									Mo.     Day          Year
Address________________________________________________________
City, State, Zip_____________________________________________	_________________________	
									(Area code) Phone No.		
Instrument (recommended)_________________________________________
Has student played this instrument before?  Yes____    No_____     If yes, how long?__________
Please indicate your scholarship teacher preference for this student.__________________________
Name of Parent(s)__________________________________________________________________
No. and street_________________________________________________________
City, state, Zip_________________________________________________________
(area code), Phone number_________________________________________
Name of Recommending Teacher______________________________________________________	
	Current teaching assignment and building________________________________________
	Teacher can be contacted at (phone and/or email address)___________________________
A dated statement of the recommendation of the current school music teacher should be placed on the back of this form or on an attached page.      Please type or use ink.    Unreadable statement will not be considered.
When writing your recommendation please indicate your reasons for considering this student to be a musically talented and/or gifted individual in addition to being a student in need of financial assistance. The bylaws of the CMF state that the Foundation is organized to provide music scholarships for private lessons to “musically talented and/or gifted” students who are in “financial need”.  The Board considers the recommendations of music teachers to determine whether the applicant qualifies as musically talented and/or gifted.  The Board uses free or reduced school lunch program guidelines to determine financial need.
Send completed form to:				Janice Spitalniak                                                                                                       
Due no later than 				3903 Prange Drive
September 13, 2023				Lafayette, In 47905