APPLICATION for ASSISTANCE                             2021		
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   ___________________________________________________________________
				No. and Street
 ___________________________________________________         _______________________
			City, State Zip				           (Area Code)  Phone Number)

Instrument (Recommended)__________________________________________________

Has the student played this instrument before?  Yes___  No____       If yes, for how long?______________

Please indicate your scholarship teacher preference for this student._______________________________

Name of Parent(s)_______________________________________________________________________

Parent’s Address and Phone if different from student’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 statements 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 10, 2021		Lafayette, IN  47905
			
					Or to spitalniakjl@gmail.com