Kindermusik with Kat! Scholarship Application

Kindermusik with Kat!

Kathleen Wayland

830-643-0668

www.kindermusikwithkat.com

Kindermusik with Kat!
Scholarship Application

Please fill out the information below to apply for a scholarship to Kindermusik with Kat!

Child's Name:	Age on Sept. 15, 2009:
Birthday:	Gender:
Parent's Name(s):
Address:
City:	Zip Code:
Home Phone:	Alternate Phone:
Email Address:
First Names and Birthdays of Siblings:
Medical Information and/or Food Allergies:
How did you hear about Kindermusik with Kat?

Classes and Available Times

View the classes and available times.

Class Selection

Please select your first choice, second choice, and third choice. List the day, time, and name of the class. (For example: Monday 11:30am Our Kind of Day)

	First Choice:
	Second Choice:
	Third Choice:

Scholarship Information

What assistance are you looking for?

Describe your extenuating circumstances.

List and describe all other activities all the children in the family are involved in.

What is your average annual household income? Please check one.
   $0-$18,000
   $18,000-$35,000
   $35,000-$60,000
   $60,000-$90,000
   Above $90,000

Other information you want to be considered.

* Approved families will be asked to commit to consistent and punctual attendance, use of the home materials for reinforcement, and confidentiality of receipt of the scholarship.