Stage 2 Scholarship Application & Registration

*Partial scholarship assistance is available thanks to the Hollowell Dawkins Foundation and kind donations of some big-hearted members in our little community!* The following scholarship application serves as your registration as well as application for financial assistance; there is no need to fill out another form.

RM_Stats
Child&#39s First Name^*
Child&#39s Last Name^*
Child&#39s Birthdate^*
Parents' Names^*
Email^*
Address Line 1^*
Address Line 2
City^*
State^*
Zipcode
Home Phone
Cell Phone^*
Allergies/Medical Restrictions
How did you hear about us?
For which session(s) are you registering?^*
Fayetteville Stage 2: 10AM-11AM

Fayetteville Stage 2: Guitar 11AM-12PM

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:
Are you requesting scholarship assistance for another child in your household?^*
Yes

No

Terms & Conditions^*
If a scholarship recipient misses a number of days in a session without notifying HeartStrings, they may not be eligible for future scholarships. I understand that this course has set dates. Any student-missed classes will not be refunded or made up. Cancelled classes due to inclement weather will be announced by text message and a make-up class will be offered.
I accept
Permission to take photographs
I give HeartStrings Academy permission to use photographs taken during classes for promotional purposes. Photos may be used in newspapers, marketing, website, social media, etc.
I accept

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Stage 2 Scholarship Application & Registration

HeartStrings Alexandria

HeartStrings Lewisburg

HeartStrings Beckley

Stage 2 Scholarship Application & Registration

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HeartStrings Alexandria

HeartStrings Lewisburg

HeartStrings Beckley