CGOC PRIVATE LESSON SCHOLARSHIP APPLICATION

All information provided will be held in strict confidence and known only by members of the scholarship committee. Information will be used solely to determine eligibility private lesson scholarships.

Grade:

Musician Information: Name: Address: City/State/Zip: Phone:

Orchestra: Instrument: School:

Parent Email:

Family Information:

Occupation: Occupation:

Number in Family:

Name of Father/Guardian: Name of Mother/Guardian: Marital Status: Ages of Children: Amount of child support received: Number of children in college:

Total college expenses:

Financial Information:

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Attach a copy of your federal tax return from the previous year (required) Note: If you itemize, you must also include a copy of Schedule A.

Last year's taxable income as reported on federal tax form (line 39 of form 1040): Last year's medical & dental expenses not paid by insurance: Amount of elementary or secondary tuition to be paid this year: Cost of an individual music lesson: $ Total cost (September through May):$

Total cost you would be willing able to pay for private lessons each week: $

Please list other musical expenses:

Special Circumstances to be considered: (Please attach separate sheet)

Private Teacher Information: (required)*** Any scholarship monies awarded for lessons are paid directly to this private teacher.

Name: Phone: Street Address: City/State/Zip: Email:

OR

O

Please assign me to a school private teacher!

All musicians receiving CGOC financial assistance will be expected to show up to all private lessons and practice weekly for your lesson and school rehearsals.