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Request an Instrument - Step Up
Who is eligible: Any student between the ages of 14 and 18 and can demonstrate financial need.
Instrument Request Form - Step Up
*
Indicates required field
School Name
*
Instrument Requested
*
Flute
Clarinet
Trumpet
Trombone
Alto Sax
Tenor Sax
Percussion Kit (snare drum & bells)
Drum Set (standard 5 piece)
Violin 1/2
Violin 3/4
Violin 4/4 (full size)
Viola 13"
Viola 14"
Viola 15"
Cello 1/2
Cello 3/4
Cello 4/4 (full size)
Acoustic guitar
Electric guitar
Electric bass guitar
Other
(If Other Please Specify)
*
Parent/Guardian Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Contact Email
*
Phone Number
*
Please describe your financial need. Include household income and family size
*
This information provided is true and factual (Student - type your name)
*
Student's Name
*
First
Last
Age
*
M / F
*
Male
Female
Other gender identification
Prefer not to answer
Student Is:
*
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Pacific Islander
White
Prefer not to answer
Ethnicity:
*
Hispanic/Latino
Non-Hispanic/Latino
Prefer not to answer
Please describe your musical goals and include any awards and honors (Limit to 1 page)
*
Max file size: 20MB
Please attach a letter from your teacher recommending you for this scholarship (limit to 1 page)
*
Max file size: 20MB
How did you hear about Ted Brown Music Outreach
*
This information provided is true and factual (parent - type your name)
*
Submit
Downloadable form
Form in Spanish
outreach_request_instrument-step_up.docx
File Size:
41 kb
File Type:
docx
Download File
outreach_request_instrument-step_up_spanish.docx
File Size:
41 kb
File Type:
docx
Download File
outreach_request_instrument-step_up.pdf
File Size:
112 kb
File Type:
pdf
Download File
outreach_request_instrument-step_up_spanish.pdf
File Size:
79 kb
File Type:
pdf
Download File
Home
About
Staff
Facts
Current Needs
Programs
Music Therapy Groups
Instrument Exploration Camp
Take 5 Jazz Improv Class
Live It OutLoud Summer Rock Camp
Donate
Events
Request an Instrument
Request an Instrument - Beginner
Request an Instrument - Step Up
Scholarships
Summer Camp Scholarships
Music Therapy Scholarship
Contact
Music Therapy
Music Therapy Groups
>
Sprouting Joy
Soothing Sounds
Music Supports: Teens
What We Do
>
Individual Therapy
Online Therapy
Schools
>
On Beat - SEL-Focused Music Therapy
Our Music Therapy Team
Blog
Subscribe e-newsletter