EmailMe Form - WMJS Scholarship Application

Name *

First Last

Email

Birth Date *

MM / DD / YYYY

Phone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Parents *

Parents' Address if Other than Applicant

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Academics

High School / College Last Attended *

GPA *

Instrument(s) *

Private Instructor(s) *

Ensemble(s) or Group(s) in Which You've Performed *

Describe Major Area(s) of Interest, Ambitions, and Goals in Music *

Do You Have Other Scholarships or Financial Aid? *

Yes

No

If Yes, Please Describe, Including Dollar Amounts

List School You Will Be Attending and Student ID# *

References

Please List at Least Two References that We May Contact to Request Information:

Name *

First Last

Phone *

### - ### - ####

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Name *

First Last

Phone *

### - ### - ####

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Performance Sample

Please upload an MP3 recording containing you playing or singing. Include performances of one popular song, one jazz composition or one blues number. (If printing and mailing this form, send mp3 as an email attachment to wmichjazz@gmail.com.)

This recording need not be of professional quality. Accompaniment is optional and can be live or pre-recorded.

MP3 Upload *

AUTHORIZATION

I understand that any information supplied by me or any person listed on this application who supplies information on my behalf, said information shall be held confidential and used only for the purposes of establishing my qualifications for this application by the Scholarship Committee of the West Michigan Jazz Society. (Sign with fingertip on touch screens or with mouse or trackpad.)

Signature *

Clear

Date Time *

MM / DD / YYYY

If printing and mailing the PDF version of this form, please send it to:

West Michigan Jazz Society
PO Box 150307
Grand Rapids, MI 49515