Your Name

Your Email

Address

City, State & Zipcode
Applicants must be a resident or enrolled in a learning institution within the 5-state region: MN, WI, SD, ND or IA

Best Phone Number to Reach You

Birthdate (format as: MM/DD/YYYY)

School

Grade Level

Major (if applicable)

Instrument or Voice Range

Music Teacher Full Name

Number of years studying music privately and names of previous teachers:

List your orchestral or ensemble participation in the past 2 years, not necessarily with your primary instrument. Please indicate the ensemble name and your instrument/voice with that ensemble

List specific ways you have shared your musical talents with your community

Academic and music scholarships, awards, grants or honors received in the past 2 years and the years awarded

Please list Schubert Club Programs (ie Student Scholarship Competition, Composer Mentorship, Volunteer, Five Dollar Scholar, etc) you have participated in and the year(s) you participated.

Scholarship Participants indicate competition years and highest level attained (Prelims, Finals, or prize winner)

In 1500 characters or less, please introduce yourself including 1)how your special project serves your long-term musical goals 2)any other relevant biographical information 3) special circumstances that make total payment for your project difficult by you or our family (if applicable)

Briefly summarize in 1000 characters or less your special project

Cost of your project

Amount requested

Currently secured funding

Future potential or pending sources

REQUIRED! Please indicate the precise recipient name/institution and address for check writing should you be awarded a grant. Checks are not issued directly to the applicant.

If awarded a grant by The Schubert Club, you must submit a report by Sept. 12, 2016, describing the activity and outcome, and how the goals were met. Failure to do so will disqualify the recipient from any future Schubert Club scholarships or grants. I agree

The information I have supplied in this application is accurate and truthful. I certify that any Special Grants award I receive will be used within one year following the award date solely for the purpose described in my application. If my proposed activity is cancelled or I am unable to undertake that activity, I will inform The Schubert Club immediately, and I will return the funding. I agree

Reference 1 Name (Must be current teacher):

Reference 2 Name:

(Completed recommendation forms are due by application deadline and can be emailed to kcooper@schubert.org)

Deadline: Completed application forms and letters of recommendation must be received at The Schubert Club 75 W. 5th Street, Suite 302, St. Paul, Minnesota 55102 before 4:30 pm Monday, April 1, 2016. Contact Kate Cooper at 651-292-3266 or email: kcooper@schubert.org