Mason Music Foundation Student Application
Student Information
Application Date
MM
/
DD
/
YYYY
Student's First Name
Your answer
Student's Last Name
Your answer
Student's Birthday
MM
/
DD
/
YYYY
Student's Current Age
Your answer
Street Address
Your answer
City
Your answer
Zip Code
Your answer
Current School
Your answer
Current Grade Level
What is your child's race?
How did you hear about Mason Music Foundation?
Is this student currently enrolled in Mason Music Foundation?
If yes, for how many years?
Your answer
If returning to MMF, do you have a CMS loaned instrument?
Do you have relatives in the program?
If yes, please name them:
Your answer
Please list any specific health or other needs that would be helpful for their teacher to know. Example: allergies, physical or mental challenges, medical conditions that may require attention, etc.
Your answer
Parent/Guardian Information
First Name
Your answer
Last Name
Your answer
Relationship
Child lives with...
Best telephone number where you can be reached
Your answer
What type of number is this?
Email Address
Your answer
Financial Assistance Information
Place of Employment
Your answer
Is your child currently approved for the Federal Free and Reduced Lunch Program at your school?
Household Size: The number of people in your household, including children.
Annual Income *
Total combined household income from previous year earned by all members of your household.
Your answer
Lesson Requests
Instruments of interest
Piano
Guitar
Voice
Drums
Violin
1st Choice
2nd Choice
3rd Choice
Instrument(s) previously studies (if any)
Your answer
Does the student know how to read sheet music?
Is the student in their school band, orchestra, or vocal ensemble?
If band or orchestra, what instrument?
Your answer
Does the student have daily access to an instrument at home?
If so, what instrument?
Your answer
For piano students, if you own an acoustic (real) piano, has it been tuned in the past 3 years?
Scheduling
Scheduling requests will be taken into consideration, but cannot always be accommodated. Please note that you may not receive your first choice. Efforts are made to accommodate siblings; however MMF cannot guarantee specific lesson requests.
Lesson times will be offered on weekdays between 3 and 8 pm, lasting 30 minutes. Please indicate your top 3 days and times (example: 1st -Monday at 3:30, 2nd - Tuesday at 5:00, 3rd - Thursday at 6:30)
Your answer
Signature: I certify that the information offered in this application is true and complete. I agree to inform the administration at Mason Music Foundation promptly in writing of any financial resources that may become available to me subsequent to the filing of this form. If accepted, I understand that I must re-file this form for each year my child attends MMF.
Type your full name in the field below to certify the accuracy of the information in this form and your intent to apply for music lessons with Mason Music Foundation.
Your answer
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