EmailMe Form - Sound Discoveries: Registration Form

Name of School

School District (if applicable)

Zip Code *

Name of Primary Contact *

First Last

Email of Primary Contact *

Primary Contact Phone

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

Name of Music Teacher (if not Primary Contact)

First Last

Email of Music Teacher (if not Primary Contact)

Which modules are you hoping to utilize (check all that apply) *

Science & Music

Math & Music

ELA & Music

Music

Format that the lessons will be implemented (check all that apply) *

In-School: Music Classroom

In-School: General Classroom

After-School

Undecided

Grades expected to participate (check all that apply): *

Approximate Number of Students Participating *

For groups of 8 or more learners, please complete the demographic information for your school or group to assist with our reporting to funders.

Percent Free & Reduced Lunch

Percent as number out of 100

Is your school Title I eligible?

Yes

No

N/A or Unsure

Please include any additional information or comments (optional)