Lonely Instruments for Needy Kids (LINKS)

Instrument Scholarship Request Form

Instructions for completing this form:
This form must be completed by the instrumental music teacher, not a parent or student. If all boxes are not checked, we will not be able to provide an instrument.

*Student Name *Age *Grade
*1st Instrument Choice:
*2nd Instrument Choice:

*Instrumental Music Teacher's Name:

*Instrumental Music Teacher's Email Address:

*School Name
*Principal's Name *Phone (with area code)

*Address
*City *State
*Zip Code

The student listed above has been recommended to receive an instrument from the CCM Musical LINKS Program. This student has met all of the following prerequisites for qualifying for the program:

The student is officially enrolled at our school.

The student participates or desires to participate in the instrument program at our school.

The student has demonstrated a good work ethic in the classroom.

The student is in good academic standing.

The student has demonstrated an aptitude for music.

The student is a responsible young person who will show respect for the instrument.

The student's parents or guardians have been unable to secure an instrument through conventional means.

I understand that this request will be fulfilled based on the availability of the instrument(s) requested. The instrument may be used by the above student for as long as that student participates in the school instrumental music programs. If an instrument is granted on scholarship to this student, the school agrees to monitor its use and return the instruments to the CCM Musical LINKS Program should the above student no longer need the instrument.