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
Date Format: MM slash DD slash YYYY
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
Date Format: MM slash DD slash YYYY
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Section I - Student Information