Music Grant Request Form 23 "*" indicates required fields Music Teacher ("Grantee")Grantee’s (Your) Name* Are you a middle school classroom music teacher?* Yes No Your School Job Title?* Your School Email Address* (Note: It is critical that you arrange for your school’s email server to accept emails from email@example.com and to do so prior to submitting this Grant Request Form. An automated “Confirmation” email will be sent to your school email address by the Foundation immediately following your Grant Request Form submission. If this email is undeliverable and/or your acknowledgement response is not promptly received by the Foundation, your Grant Request cannot be processed.)Alternate Email Address Preferred phone number*Phone Number Type* School Phone Cell Phone Have you or your school received a Peter R. Marsh Foundation Middle School Music Grant in a previous school year?* Yes No Middle School and Music Program InformationSchool Name* School Phone*Principal’s Name* Principal’s Email* Middle School Website Address (not district website)* School Mailing Address*(To avoid lost mail, verify this address with your school administration. Include routing instructions in Line 2, if any.) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this a public school?* Yes No What date does your academic year end?* What is the estimated total number of students in all middle school grades?* What is the estimated number of students in the middle school music class(es) that you teach?* How do you propose to use the Grant funds for music education (only) in your school?*(Refer to the Guidelines for conforming use of the Grant funds.)Are three or more student performances and visitations at senior facilities in your (or a nearby) community seemingly attainable at this time?* Yes No The nurturing of empathy and compassion in students through a post-performance student/senior visitation is a critical component of this Grant Program. Will this be accomplished?* Yes No Is it plausible that all of your music students will participate in a minimum of one performance/visitation?* Yes No If No, please provide explanation and projections.*Have you reviewed the “Music Grant Reviews” and the “Frequently Asked Questions”?*View Music Grant Reviews and Frequently Asked Questions. Yes No New Grant Applicants: How or where did you learn about this Middle School Music Grant program? Please be specific.Comments, if any (optional) * Yes, I have read, understand, and accept the eligibility requirements and conditions of this Music Grant.