Application for Student Eligibility
Music4CHIEF, Inc., is committed to providing eligible students access to music education and music performance opportunities. Eligibility for the Music4CHIEF program is based on financial need and/or recommendations from a certified case worker or counselor. Student approval is on a case-by-case basis and is dependent upon approval from the Music4CHIEF Board of Directors and available program funds. Families are responsible for notifying Music4CHIEF of any changes in financial status if they occur and Music4CHIEF reserves the right to discontinue funding as necessary. Funds will be paid directly to the music instructor or music program approved by Music4CHIEF.

**All information on this form is completely confidential**

TO APPLY:
Complete the following form and submit. 
If preferred, you may email your application answers directly to Music4CHIEF at music4chiefproject@gmail.com.
Sign in to Google to save your progress. Learn more
Student Full Name
Student Date of Birth
MM
/
DD
/
YYYY
Student Age
Student Phone (optional)
Student Email (optional)
School Attending
Grade Level
Primary Contact Name
Relationship to Student
Address
Primary Contact Home Phone
Primary Contact Cell Phone
Primary Contact Email
Preferred Contact Method
Clear selection
Annual Household Income
Clear selection
Does the student qualify for the free/reduced lunch program?
IF YOU ARE REQUESTING A DONATION INSTRUMENT: Please note which instrument you are requesting. 
**Music4CHIEF has a limited selection of available refurbished instruments for donation. Your request is not guaranteed, but every effort will be made to accommodate the request.
Please add any additional information that may be helpful in our review of this application.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms