Milpitas High School Music Boosters - Music Lessons & Camp Scholarship Application
Please do not fill out this application unless you are currently enrolled, or you are prepared to enroll in private music lessons.

Application deadline: ongoing – applications will be reviewed monthly and awarded as funding is available.

Your scholarship application will be judged in part on the following criteria:

1. Needs of the organization and student

2. Past performance in class

3. Future leadership potential

4. Best fit for the individual and organization

Rules and Guidelines:

1. The Milpitas High School Music Boosters will award up to a $200.00 scholarship per school year
for active student members of the Milpitas High School Band and Orchestra who are enrolled in
monthly private music lessons, or attend an approved music camp/training on their school instrument.

2. Recipients must have a grade of 85% or higher in their music classes.

3. The award will usually be paid directly to the student or parent at the end of your second month
of music lessons or camp attendance.

4. The student and their family are responsible for all start-up, material, and lesson costs.

5. All decisions of this Scholarship Committee are final.

6. Proof of lesson/camp payment and attendance must be provided to the music boosters before a scholarship check will be issued. (A receipt from your private music teacher or cancelled check can be submitted as proof of payment.)

7. Scholarships cannot be used for piano lessons.

Student Information
Student Name *
John Nguyen
Your answer
Grade *
City *
Student Email Address *
Your answer
Which instrument will you be taking lessons on? *
select one
Private Music Teacher Information
Your private music teacher will be contacted in order to verify enrollment, lesson tuition, attendance, progress, and payment.

Here is a partial list of local music teachers and camps:
http://milpitashs.schoolloop.com/MusicTeachers

Name of Private Music Teacher *
Your answer
Email Address *
Your answer
Web Site
Your answer
Phone Number *
555-555-5555
Your answer
Address *
1285 Escuela Pkwy. Milpitas, CA
Your answer
Planned or Actual Lesson Dates: *
Check all that apply (2 months minimum required)
Required
Actual Cost of Lessons *
examples: $98 per month, $60 per hour, etc.
Your answer
Parent Information
Proof of lesson/camp payment and attendance must be provided to the music teacher before a scholarship check will be issues. A receipt from your instructor or cancelled check can be submitted as proof of payment.
Name of parent, guardian, or student to receive scholarship payment: *
John Nguyen Sr. (payments cannot be made to instructors)
Your answer
Please provide your home address, so we may mail your scholarship check to you after you complete your 2 months of lessons or attend music camp. *
Your answer
By checking the box below, you are verifying that all of the above information is true and correct. Any changes to the above information must be approved by the MHS Music Director and Scholarship Committee. *
Required
Name of Parent/Guardian *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of MUSD. Report Abuse - Terms of Service