(to be completed by parents)

OFFICE USE ONLY
S:
T:
SC:
  

Student Information
First Name:     Last Name: 
Age:      Gender:  (optional)     Grade:      Ethnic:  Other: 

Parent(s) or Guardian(s):

First Name(s):     Last Name: 
Address: 
City:     State:    ZIP/Postal Code:
E-Mail: 
E-Mail 2: 
Home Phone:     Office:     Cell:
For OfficeUse Only:


What instrument are you interested in? 
Do you have access to a practice instrument? 
Please Describe:
Do you have transportation? 

We will try to find a teacher near your residence, but if we can't, how far are you willing to travel to lessons? Please name any surrounding towns or suburbs we can consider when searching for a teacher:



Since it isn't always possible to locate an in-person teacher, please indicate your preference below:
I can ONLY do in-person lessons.
I would prefer online lessons.
I would prefer in-person lessons, but am open to online lessons if necessary.

Do you have a teacher in mind? 
If so, please provide contact information, if possible:

School/Organization Information
School/Org Name: 
ML Teacher ID:  (If Available)

Financial Information

Our child is eligible for:

free lunch program.
reduced lunch program.
neither program.

A copy of the first page of your current tax return may be requested.

Other helpful financial information:

    

Income Eligibility Parameters:

Family of 4 - Less than $56,000
Family of 6 - Less than $75,000
Alaska: Family of 4 - Less than $69,500
Alaska: Family of 6 - Less than $93,500
Hawaii: Family of 4 - Less than $64,500
Hawaii: Family of 6 - Less than $86,000
Other:
    

Part A

(To be completed by the parent or guardian)

We want to learn what your child is doing outside of school, and what types of musical activities or interests you have observed at home. Please select the number that you feel most closely represents how often you observe your child in the following activities:

1: seldom or never    2: occasionally    3: frequently    4: almost always

My child:

  1.  remembers and sings tunes from television, radio, records, tapes and so on.
  2.  responds to the rhythm of music by moving, clapping, etc.
  3.  is particularly sensitive to sounds of all kinds, noticing small details in music and everyday sounds.
  4.  notices small details within a musical selection or in environmental sounds.
  5.  enjoys performing for family and friends, and performs with ease.
  6.  enjoys creating or experimenting with tunes, rhythms, or sounds.
  7.  is aware of slight changes in mood, loudness or softness, and sounds of different instruments in music.
  8.  sings, moves or reacts to music with expression.
  9.  shows focused concentration when listening or reacting to music.
  10.  enjoys reworking musical ideas.

Describe musical activities your child enjoys outside of school, including church choir, music lessons, family activities, etc.

    

Please offer your own evaluation of your child's musical interests and abilities.

    

Additional comments that may be helpful to the MusicLink teacher. Please include any learning challenges or disabilities.

    

Please indicate any questions you may have regarding the MusicLink program.

    

Where did you learn about the MusicLink Foundation?

    


NOTE: IT IS VERY IMPORTANT THAT YOU RESPOND TO COORDINATORS WHEN THEY CONTACT YOU. FAILURE TO RESPOND IN A TIMELY MANNER WILL DISQUALIFY YOUR CHILD FROM CONSIDERATION FOR THE MUSICLINK PROGRAM.

What is your preferred method of contact?   E-Mail    Phone Call     Text Message



Part B

(To be completed by the student. Not necessary for early childhood nominations.)

First Name:      Last: 
Age:      Grade: 
School Music Teacher: 

Please answer the following questions.

1. Do you:

  • play an instrument? yes     no     Instrument(s):     Years played: 
  • take private lessons? yes     no    Teacher:
  • take group lessons? yes     no    Teacher:
  • take lessons at school? yes     no
  • teach yourself? yes     no

2. Do you sing in a choir?     yes     no    If so, where?

2. Do you play in a band/orchestra?     yes     no    If so, where?

4. List three of your favorite songs, records or tapes.

    

5.What musical activities do you like?

    

6. Describe what you like best about musical things you do.

    

7. What other interests do you have?

    

8. What else would you like us to know about you?

    



  

The MusicLink program provides lessons at a reduced fee to students who show musical promise. The student is nominated by a school teacher or youth organization leader who notices enthusiasm and interest in music. The program links this student with a music teacher who volunteers to teach at a reduced rate through the MusicLink program. The MusicLink Foundaton does NOT reimburse the teachers for this tuition discount. The MusicLink Foundation collaborates with professional music teachers who are members of national music teacher organizations or performing groups to provide quality instruction for MusicLink students. Once this link is in place, the MusicLink teacher assumes responsibility for this student's instruction. The student and his or her parents/guardians agree to abide by the individual policies and guidelines set forth by their MusicLink teacher.

Please read over the policy sheet and sign below to show you accept the following requirements as stated. Failure to abide by these requirements may result in the loss of this opportunity.

The family will:

  • participate in an introductory interview with the MusicLink teacher to go over specific studio requirements and financial arrangements of lessons.
  • provide financial support for lessons as determined by the program.
  • provide transportation to lessons when applicable.
  • ensure regular attendance at lessons and give reasonable advance notice if a lesson MUST be missed.
  • provide a suitable place and time for musical practice.
  • support the child's musical activities at home, school, and in the studio.

The student will:

  • arrive at scheduled lessons on time, with required music books and assignments well prepared.
  • maintain consistent practice of music assignments andc omplete written theory work.
  • participate in performances and other studio activities.

The MusicLink teacher will:

  • instruct the student in a manner similar to other students in the studio, with the same student requirements and opportunities.
  • keep the scholarship status of the student confidential within the studio.
  • inform parents of student progress in the program through annual student evaluations.

CONSENT TO PARTICIPATE

As parents/guardians, we give our permission for our child to participate in the MusicLink program. I recognize that the MusicLink Foundation's function is to assist in linking our child with a music teacher working independently or through a community music school, college, or university, or music business. I understand that the MusicLink Foundation assumes no legal responsibility for claims arising from this instruction, and agree to hold harmless MusicLinkFoundation from all legal claims arising in connection with such instruction.


 Date: 
I agree:
 

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