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Pre-Qualification Form

Schools must meet the following guidelines to be eligible for consideration of a grant:

School must serve a minimum of 65% economically disadvantaged students
School must have an established instrumental music program that is offered during the regular school day; all types of instrumental programs qualify (i.e. band, strings, mariachi, guitar labs, keyboard labs, jazz band, modern band, etc.)
School must have an existing inventory of instruments
School must have a dedicated instrumental music room with adequate and secure storage for musical instruments

School/Program Information

School Name:

School Address:

City:

State:

Zip:

School County:

School District:

Phone:

Ext:

Fax:

School E-mail:

Website Address:

Your Information

Prefix:

First Name:

Last Name:

E-mail Address

Your Phone:

Relationship to the Music Program:

Music teacher, principal, etc.

Information About Your Music Program

Do you have an established instrumental music program that is at least three years old?

(General classroom music and Orff style programs do not qualify as instrumental.)

Yes
No

Does your school have a dedicated classroom for instrumental music classes? Please note that cafeterias and auditoriums do not qualify as a dedicated classroom.

Yes
No

Is your music teacher:

Full Time
Part Time

How many years has the instrumental music teacher been teaching at the applying school?

Are you a Title 1 public school?

Yes
No

What percentage of the school's total student population participates in the Free/Reduced Lunch Program?

What percentage of students participating in the instrumental music program also participate in the National School Lunch Program?

Do you have an inventory of instruments?

Yes
No

What percentage of students participating in the instrumental music program supply their own instrument rather than borrowing a school/district instrument?

If awarded, how many students would directly benefit from the donated instruments?

If awarded, what need would the donated instruments fulfill?

Program Budget

What is the annual budget for your music program EXCLUDING teacher salaries?

How much of your budget is spent on the following?
Materials
Instruments
Repairs
Events
Uniforms
Performances
Travel
Scholarships
Other

If other, please explain:

Basic Information

Have you applied to the foundation before?

Yes
No

Was your school recently impacted by a natural disaster?

Yes
No

How did you hear about us?

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OTHER
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