Music Scholarship Application (2026-27)"*" indicates required fieldsCommentsThis field is for validation purposes and should be left unchanged.STUDENT INFORMATIONStudent First Name*Student Last Name*Student birthdate* Student Address* Street Address City State / Province / Region ZIP / Postal Code Student School (if applicable)Student Grade (if applicable)Tell us about yourself!*What are your hobbies or interests?*If you were an animal, what animal would you be? And why?*List three words that describe your personality:*What department would you like a scholarship to cover? (Select 1)* Clarinet | Private Music Instruction Flute | Private Music Instruction Guitar | Private Music Instruction Piano | Private Music Instruction Strings | Private Music Instruction Voice | Private Music InstructionAre you currently taking Music Lessons at 171? If so, whith whom?PARENT / GUARDIAN INFORMATIONFirst Name of Parent / Guardian*Last Name of Parent / Guardian*Parent / Guardian Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select County*Chemung CountySteuben CountySchuyler CountyTompkins CountyPhone*Email* Does the student live with you? Elsewhere?*Total Annual Household Income:* Under $50,000 $50,000 - $100,000 $100,000 - $150,000 Over $150,000Employer*Length of Employment*Title*Total number of people in household*PAST SCHOLARSHIP / FINANCIAL AID INFORMATIONHas the student taken any classes at 171 before? If yes, which one(s)?Has the student applied for a 171 scholarship / financial aid before?*Are there any circumstances you feel we should know of when considering your application? Please provide information:*BY APPLYING FOR SCHOLARSHIP / FINANCIAL AID FUNDING, I AGREE TO THE FOLLOWING TERMS:• To attend class regularly.• To help create a positive atmosphere for all to learn. • To complete a class evaluation at the completion of the class. • To write a thank you note or draw a picture to the scholarship funder at the end of class. • To participate in group exhibitions, concerts, or recitals that may be part of the lesson plan for the class I take.I have completed this form accurately, in good faith, and to the best of my knowledge.*Digital Signature of Guardian
