Is the student a returning BAMA student?* --None-- Yes, a returning scholarship recipient Yes, a returning student, but has never before received a scholarship No, this student has never attended BAMA for lessons

Is the student applying as a beginner or experienced student?* --None-- Beginner Experienced

If experienced, please create a video of the student performing 1) a scale in any key and 2) a recent piece, and provide a URL for your video. The easiest way to do this is to upload your video to YouTube or Google Drive and then submit a link:

Please select any programs in which the student is a current participant: Φ DREAMS of Wilmington Wilmington Symphony Youth Programs School Orchestra Music is Life! preschool classes Music Together Other

Does the student currently own the instrument they wish to study?* --None-- Yes No

If the student does not own the instrument, would you like to request an instrument from BAMA for the duration of their enrollment?* --None-- No Yes

Student First Name*

Student Last Name*

Student Birthdate* --None-- January February March April May June July August September October November December   --None-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  

Student Preferred Pronouns --None-- She/her He/Him They/them Prefer not to say Other

School Student Attended Last Year

Desired Instrument of Study* Harp Piano Violin Viola Cello

Desired Lesson Type* 30-minute lessons with faculty teacher 45-minute lessons with faculty teacher 60-minute lessons with faculty teacher All students ages 3-5 years old: Suzuki group class

Demographic Identification Φ American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian or other Pacific Islander White Bi-racial I prefer not to say Other

If student has any learning differences, please describe:

Primary Contact:

Relationship to Student* --None-- Mother Father Legal Guardian Other

First Name*

Last Name*

Email*

Phone*

Street*

City*

State*

Zip*

Parent/Guardian Marital Status* --None-- Married Separated Divorced Widowed Single

What is your annual household income?* --None-- Less than $24,999 $25,000 to $39,999 $40,000 to $69,999 $70,000 to $99,999 $100,000 or more

What amount do you feel you can pay monthly?*

How many dependents are in your household (including yourself)?*

Briefly explain your need for this scholarship and note any extenuating circumstances.*

Use the space below to provide information for additional adults who would like to be contacted by the school (ex. parents).

Adult Contact (1):

First Name

Last Name

Relationship --None-- Mother Father Sibling Grandmother Grandfather Aunt Uncle Cousin Friend Legal Guardian Other

Phone

Email

Adult Contact (2):

First Name

Last Name

Relationship --None-- Mother Father Sibling Grandmother Grandfather Aunt Uncle Cousin Friend Legal Guardian Other

Phone

Email

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