Student's Name
Birthdate
Parent's Name
Address
City
Zip Code
State
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Cell Phone: (Optional)
Email
Occupation Of Mother
Single or Married?
Single Married Occupation Of Father
Adults living in the home
Number of financially dependent children
Total Household Annual Income
What is the amount of tuition you will be able to pay per month?:
Briefly describe your need for financial assistance and what you hope Music Time Learning Center can provide for you and your child.
Are you currently enrolled in a Music Time Learning Center class?
Yes No
Have you previously received a scholarship from Music Time Learning Center?
Yes No Class You Are Applying For
Village Our Time Imagine That For The Young Child Family Time Music Box Piano ABC Music and Me (Special Needs) Camp
I understand that if I am awarded a scholarship I must attend at least 75% of the classes, tuition payments must be satisfied and on time in order to be eligible for future scholarships. I also certify that the information entered in this form is complete and accurate to the best of my knowledge.
