ESYO Summer 2021 Private Lesson Scholarship Application (Confidential)
Please fill out completely to continue your current scholarship or to apply for one for the summer only: June-September 2021. This scholarship is for private lessons, $25 per lesson that is paid directly to your teacher. Once we receive your application, we will send you instructions and procedures. Thank you for helping your student continue to grow musically!
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Student First and Last Name *
Ensemble/Orchestra *
Please list the MONTHLY amount for EACH household member who earns income. Be sure to total all at the end, and include total number of people living in household.
Family Member 1 Name: *
TOTAL Monthly Income for Family Member 1 (include benefits you receive from any agency) *
Family Member 2 Name:
TOTAL Monthly Income for Family Member 2 (include benefits you receive from any agency)
_________________________________________________
Family Member 3 Name:
TOTAL Monthly Income for Family Member 3 (include benefits you receive from any agency)
_________________________________________________
TOTAL HOUSEHOLD MONTHLY INCOME (add all family member income from above) *
TOTAL number of people living in your household (including children and anyone dependent on total household monthly income) *
Declaration 1: I agree to pay any remaining balance in full or set up a payment plan as listed in section 7 of my registration. *
Declaration 2: I understand that ESYO reserves the right to request additional supporting document(s) to verify the above-stated income. *
Declaration 3: I understand that the participant's previous accounts with ESYO must be current in order to be awarded a scholarship. *
Declaration 4: I understand that the information on this form must be accurate and is given for the sole purpose of determining qualifications for awarding an ESYO Scholarship. *
Parent or Legal Guardian Name (by entering my name I agree to the above declarations) *
Parent or Guardian Email: *
Preferred Phone Number: *
Please look over your application carefully and then click SUBMIT. We will contact you as soon as possible. Thank you!
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