School Music Application

Date / Time

Date

Time

Name of School

Name of Teacher

Phone number to contact Teacher

Teacher's email

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Website / URL for school or program

Type of service requested (check all that apply)

Printed music for instruction
Recorded music for instruction
Musical Accompanist
Uniforms
Travel Expenses to a performance venue for a band, orchestra, choral group or a member thereof

Total request (not to exceed $500.00)

Upload supportive documents below. If multiple services requested above, please itemize with a total.

number be service

File Upload - use to add quotes, invoices or supporting documents

Drag & Drop Files, Choose Files to Upload

Please use the space below for any additional information that may be helpful to the Committee in reviewing this application. e.g., the level of instruction or instrument type

I certify that the information on this application is true and correct to the best of my knowledge.

Yes

Signature of Teacher

First

Last

About N.D.G.W.

Information

Governance Policies

School Music Application