Singer/Songwriter Scholarship Application & Registration

Student Type:^*

Adult
Child

Student&#39s First Name^*

Student&#39s Last Name^*

Student&#39s Address

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Country

Zip ^*

What is the preferred email address to receive HeartStrings communication?^*

Student Email (if different from preferred email entry for HeartStrings communication)

Home Phone

Cell Phone^*

Student&#39s Birthdate^*

Student Gender^*

Parents' Names^*

Parent Address (skip if registering as an adult or same as above address)

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Country

Zip ^*

Who will be the primary practice parent/contact?^*

Current musical groups or orchestras you'll be with this year:

Grade:^*

School Music Teacher:

Session Selection(s)/Skill Level^*

Kids Singer/Songwriter - Level 1 - 30 min (37 lessons @ $50 ea. & 8 jam parties @ $50 ea. yearly)
Kids Singer/Songwriter - Level 2 - 45 min (37 lessons @ $75 ea. & 8 jam parties @ $50 ea. yearly)
Kids Singer/Songwriter - Level 3 - 60 min (37 lessons @ $100 ea. & 8 jam parties @ $50 ea. yearly)
Singer/Songwriter for Adults (All levels) - 60 min (37 lessons yearly @ $100 ea.)

Allergies/Medical Restrictions

How did you hear about us?

What is your monthly gross income?^*

Please explain why you are applying for a scholarship, listing any special circumstances that would give a complete picture of your family’s financial situation.^*

Excluding adults, list other dependents in household and their birthdays:

Choose your preferred way to pay tuition (Following registration, an email will be sent detailing your rate and payment plan.)^*

Monthly auto debit on the 1st of each month
Quarterly auto debit on 9/1, 12/1, 3/1, 6/1
Two auto debits per year on 9/1 and 3/1
One auto debit per year on 9/1

We offer $20 off yearly tuition for using a bank account to make tuition payments rather than a credit card! Are you interested in receiving this discount?

Would you like to make your contact information available to other HeartStrings students/parents solely for the purpose of lesson swapping?^*

HeartStrings Parent's Guide & Policies (Click link at top of page to view)^*

I have read the full "HeartStrings Academy Parent Guide & Policies"

I accept

Permission to take photographs

I give HeartStrings Academy permission to use photographs taken during HeartStrings lessons and events for promotional purposes. Photos may be used in newspapers, marketing, website, social media, etc.

I accept

Missed Lesson Policy

I understand the missed lesson policy and will refer to it when lessons are missed to determine allowed options.

I accept

Payment Authorization^*

If I am awarded a scholarship application and choose to accept the award, I will provide an electronic payment method for payment of the reduced tuition amount. I authorize HeartStrings Academy to initiate electronic debit entries for payment of tuition drafts based on the payment option selected. I understand that I may quit at anytime, but there will be no refunds for auto debits already made.

I accept

Singer/Songwriter Scholarship Application & Registration

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Singer/Songwriter Scholarship Application & Registration

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HeartStrings Alexandria

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