Barbara Schneiderman Memorial Fund for Piano Enrichment Application

Section I - Student Information

Name

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Section II - Information

Name of School Currently Attending

# of years of piano lessons

Suzuki level

Music Teacher

What Suzuki camp or convention do you plan to attend?

Section III – Extra-curricular activities and awards & honors

Extra Curricular Activities

Please list any activities such as sports, school club, community service or volunteer experience over the past 3 years.

Piano Honors and Awards

Please list any honors or awards you have received in the past 3 years (for example: Guild, Certificate of Merit, festivals, etc).

Section IV – Personal Statement

Completed by

Parent
Student

In the space below, please describe how this scholarship will enhance you or your child’s music education and facilitate your participation in this camp.

Student Signature

Date

A parent or guardian’s signature is required My signature serves as permission for the Coastal Community Foundation to publish my child’s name and photos in the event he/she receives a scholarship. Furthermore, I agree to release and hold harmless the Foundation

Parent Contact Information/Signature

Parent Name

First Last

Parent Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent Phone

Parent Email

Parent Signature

Date

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