Request for Financial Aid + Registration Form

Please complete the below form in it’s entirety and provide required proof of income documents to office. Incomplete applications will not be considered for financial aid.

First, read the following: Financial Aid: Principles, Guidelines, & Expectations
& HNMC Rates & Policies

Annual Registration fee ($40 for the first student, and $15 for each additional student) must be paid upon acceptance of financial aid, and prior to starting lessons.

Please fill out separately for each student applicant. **Additional family requests may refer question fields marked (+) to first applicant’s completed answers.

HNMC REQUEST FOR FINANCIAL AID + STUDENT REGISTRATION

Student Name(required)

Student Birthday(required)

Student Age(required)

If new student, How did you hear about HNMC?(required)

Parent/Payor Name(required)

Email(required)

Phone Number(s)(required)

Mailing Address (include City, ST, Zip)(required)

Billing Address, if different than above

Instrument(required)

Instructor or TBA (To be arranged)(required)

Preferred Start Date

If Yes, Date of First Lesson

If Yes, when? Indicate amount(s) received previously(required)

FINANCIAL AID is based on 30 min TUITION. The students will be enrolled in full time weekly instruction until the end of the instructional year, with a mid-year and end year review in Jan & Jun.

TUITION - due in advance by 5th of month. Subject to late fee after 15th. Failure to pay may result in cancellation of lessons with reinstatement only upon payment in full. 2 weeks notice is required for discontinuation. No refund or credit for lessons missed by the student. Lessons missed by the teacher will be made up or credited (see Rates & Policies).

Total Monthly 30 min Tuition Amount $124.69

Amount you are able to pay monthly (Please pay as much as you are reasonably able to) $

Amount of Aid requested (124.69 - amount able to pay) $

Questions marked (+) are only required for first family member applicant. (**see NAME)

(+) Total Annual Income for Family (include all sources of income)**(required)

(+) How many children are in household?**(required)

(+) How many adults are in household?**(required)

(+) Number of others being supported, relationship (Other dependents)**(required)

(+) Please describe any special circumstances which affect your need for financial assistance. ie: Why you need aid / Why learning music is important to you. (Copy and paste into field, if easier)**(required)

As part of the Financial Aid Principles Guidelines & Expectations, students agree to arrive on time and prepared for lessons (subject to teacher review), turn in a handwritten thank you note to the Scholarship Committee, and complete the basic service requirement.

Signature:(required)

I have read the Financial Aid Principles Guidelines & Expectations & the Rates & Policies of HNMC and submit this request.

Electronic Signature of Person Responsible for Payment (Type Name)(required)

Electronic Signature of Student (Type Name)(required)

Date signed(required)

Proof of Income. You must provide a copy of your most recent Federal Income Tax form (1040; 1040A; 1040EZ, first two pages only) and/or additional documents to show proof of income if you were not required to file taxes this last year.(required)

I understand that I must turn in the required proof of income documents to the office for my application to be complete.

Make sure all (required) fields are completed before pressing Submit

Financial Aid: Principles, Guidelines, & Expectations
Rates (click here for explanation of Tuition and Variable payment options)
Photo Consent

Your form will be sent to our office upon pressing the ‘Submit’ button. Look out for an emailed confirmation of receipt within 1-2 business days.

SEND PROOF OF INCOME: Please white out all SSN & acct routing #’s on proof of income documents. Email to music@hnmc.org, Mail to Attn: Office Manager 3910 W. Custer Dr. Spokane, WA 99224, or drop through mail slot in HNMC office door. (First 2 pages only of simple tax return + explanation or proof of any additional sources of income not reflected on your tax return.)

Contact our office with any questions at (509) 326-9516, or music@hnmc.org

Holy Names Music Center

Spokane's Community Music School

Request for Financial Aid + Registration Form