CODA Application

“The CODA Project” SCHOLARSHIP REQUEST FORM

All applications will remain confidential and your information will not be shared outside of our organization or participating partners.

All applications need to be completely filled out in order to submit. Any application that is not filled out in entirety will be sent back for correction and could delay the process.

Have you applied to CODA before?

Yes

Student's Name

First Name

Last Name

First Instrument Choice

Second Instrument Choice

Instrument Size

This field is only needed if your child selected Violin, Viola, Cello, or Upright Bass.

Name of Parent/Guardian

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent / Guardian Date of Birth

Must be 18

YYYY

Relationship to Student

Number or Persons in Household

This includes anyone living within your household, all ages.

Gross Annual Income of All Household Members

Income includes the following: (1) Monetary compensation for services, including wages, salary, commissions or fees; (2) net income from nonfarm self-employment; (3) net income from farm self-employment; (4) Social Security; (5) dividends or interest on savings or bonds or income from estates or trusts; (6) net rental income; (7) public assistance or welfare payments; (8) unemployment compensation; (9) government civilian employee or military retirement, or pensions or veterans payments; (10) private pensions or annuities; (11) alimony or child support payments; (12) regular contributions from persons not living in the household; (13) net royalties; and (14) other cash income. Other cash income would include cash amounts received or withdrawn from any source including savings, investments, trust accounts and other resources that would be available to pay the price of a child's meal.

Do you agree to support this child’s decision to join Band or Orchestra, by giving them time to practice and encouraging them to play and learn their instrument?

Yes

School Information

The student is officially enrolled at our school. The student has demonstrated good work ethic and behavior in the classroom. The student has agreed to show respect for the instrument and will care for it while in their possession. We will use the information provided below to inquire with your teacher about the prerequisites above and the information you provided.

Music Teacher's Name

First Name

Last Name

Music Teacher's Email

School Name

By clicking "apply now", you agree that all information provide is accurate and that you have been unable to obtain an instrument through conventional means. You also understand that this request will be fulfilled based on the availability of the instrument requested. The instrument may be used by the above student for the full academic year in which the student is applying. If an instrument is granted to this student, the school and parent or guardian agree to monitor its use and return the instrument to the The CODA Project program should the above student no longer need the instrument.