Plugged In Band Program · Private Lesson Scholarship Application

Student Information

Student Name

*

First Name

Last Name

Parent Contact Information

Parent 1 Name (primary contact)

*

First Name

Last Name

Parent 1 Primary Phone

*

Parent 1 Email

*

Verify Email

*

Private Lesson Packages

Lesson Packages

*

4-weeks

8-weeks

Lesson Length

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30 minutes

45 minutes

1 hour

Scholarship Information

Plugged In's scholarship fund was created to meet the need of those students who are interested in participating in Plugged In, but whose family may not have the financial resources to pay full tuition. Plugged In's goal is to ensure music instructions and a welcoming community to all young musicians. To help determine a family's need for scholarship, applicants must provide the requested financial documentation. Applicants are also able to share and factor in extenuating circumstances that may effect their ability to pay tuition. Examples of extenuating circumstances can include but are not limited to, limited income, sudden death or abandonment of the primary provider, single parent households, etc. Applicants may be asked to provude additional documentation to illustrate their need to qualify such as recent pay stubs, letters of reference, etc. Plugged In is committed to ensuring all young musicians have access to programming.

Number of Family Members

*

How many people are in your immediate family?

Please enter your family's combined gross income.

*

This is typically line 37 on your IRS tax form 1040.

Please provide us with a copy of your most recent years IRS form 1040.

*

.pdf and .jpg file types accepted. Upload limited to 10MB. If you are unable to provide an electronic copy of your IRS 1040 form please contact Plugged In at info@pluggedinband.org for support.

Please describe any extenuating circumstances that dramatically effect your family's listed gross income.

Examples of extenuating circumstances can include but are not limited to - limited income, sudden death or abandonment of the primary provider, singe parent households, care of a child with a disability or aging family members, etc.

Scholarship Sliding Scale

Private Lesson Sliding Scale FINAL 4 week.jpg

Scholarship Sliding Scale

Private Lesson Sliding Scale FINAL 8 week.jpg

Please select your level of scholarship.

*

Please choose the appropriate scholarship level for your family based on the sliding scale chart above. If you have described an extenuating circumstance above please select the scholarship level that best fits your current circumstance. You will be contacted if Plugged In requires additional information regarding your choice of scholarship level.

Level 1 - $105 (total tuition for 4 weeks)

Level 2 - $70 (total tuition for 4 weeks)

Level 3 - $35 (total tuition for 4 weeks)

Level 4 - $7 (total tuition for 4 weeks)

Please select your level of scholarship.

*

Please choose the appropriate scholarship level for your family based on the sliding scale chart above. If you have described an extenuating circumstance above please select the scholarship level that best fits your current circumstance. You will be contacted if Plugged In requires additional information regarding your choice of scholarship level.

Level 1 - $135 (total tuition for 4 weeks)

Level 2 - $90 (total tuition for 4 weeks)

Level 3 - $45 (total tuition for 4 weeks)

Level 4 - $9 (total tuition for 4 weeks)

Please select your level of scholarship.

*

Please choose the appropriate scholarship level for your family based on the sliding scale chart above. If you have described an extenuating circumstance above please select the scholarship level that best fits your current circumstance. You will be contacted if Plugged In requires additional information regarding your choice of scholarship level.

Level 1 - $210 (total tuition for 8 weeks)

Level 2 - $140 (total tuition for 8 weeks)

Level 3 - $70 (total tuition for 8 weeks)

Level 4 - $14 (total tuition for 8 weeks)

Please select your level of scholarship.

*

Please choose the appropriate scholarship level for your family based on the sliding scale chart above. If you have described an extenuating circumstance above please select the scholarship level that best fits your current circumstance. You will be contacted if Plugged In requires additional information regarding your choice of scholarship level.

Level 1 - $180 (total tuition for 4 weeks)

Level 2 - $120 (total tuition for 4 weeks)

Level 3 - $60 (total tuition for 4 weeks)

Level 4 - $12 (total tuition for 4 weeks)

Please select your level of scholarship.

*

Please choose the appropriate scholarship level for your family based on the sliding scale chart above. If you have described an extenuating circumstance above please select the scholarship level that best fits your current circumstance. You will be contacted if Plugged In requires additional information regarding your choice of scholarship level.

Level 1 - $236 (total tuition for 4 weeks)

Level 2 - $158 (total tuition for 4 weeks)

Level 3 - $79 (total tuition for 4 weeks)

Level 4 - $16 (total tuition for 4 weeks)

Please select your level of scholarship.

*

Please choose the appropriate scholarship level for your family based on the sliding scale chart above. If you have described an extenuating circumstance above please select the scholarship level that best fits your current circumstance. You will be contacted if Plugged In requires additional information regarding your choice of scholarship level.

Level 1 - $360 (total tuition for 8 weeks)

Level 2 - $240 (total tuition for 8 weeks)

Level 3 - $120 (total tuition for 8 weeks)

Level 4 - $24 (total tuition for 8 weeks)

Policy

To participate in Plugged In you must read, understand, and agree to the following policies. If you have questions regarding any of the following policies please contact Plugged In directly.

Read Cancellation and No-show Charge Policy

Read Release of Liability / Indemnity / Emergency Treatment Agreement

Read Code of Conduct Agreement

The student and guardian have read and agree to the Cancellation and No-show Charge Policy

*

Yes

The student and guardian have read and agree to the Release of Liability / Indemnity / Emergency Treatment Agreement

*

Yes

The student and guardian have read and agree to the Code of Conduct Policy

*

Yes

Payment

Please take note of the level of scholarship the student has applied for (Level 1-4). This information will be needed when registering for private lessons.

All students regardless of their level of scholarship must have a credit/debit card on file. Once your scholarship application has been submitted a registration link will be provided via a confirmation page and email. Students can register immediately after submitting the Scholarship Application Form. Students will be required to enter payment information during the registration process.

If you do not have a credit/debit card please contact Plugged In for support before registering for private lessons.