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Parent First name

Parent Last name

Email

Phone

Student First Name

Student Last Name

How did you hear about us?

Friends

Social Media

Google

Other

Grade of student K-12

What was your Gross Household Income last year?

Total number of people in your household

Does the student has access to a phone or computer for the purpose of zoom sessions?

Does the student has daily access to a cello.

Does the student have access to a reliable internet connection for the purpose of zoom sessions?

The following is for verifying your household income.

You have two options for verifying income (You only only need to do one):

-Uploading paystubs

-Uploading Page 1 of last years Form 1040 (tax form) For Paystubs: Upload 3 clear photos of your 3 most recent pay stubs.

Show dates and gross pay; feel free to black out SSN, bank info, or anything private.

For Form 1040: Upload a clear photo of last years Form 1040. Show dates and gross pay; feel free to black out SSN, or anything private.

Household income (pay stubs, 1040, etc.)

Is there ANY other income in the home?

No

Yes → If yes, upload proof of that income too (pay stubs, 1040, etc.)

Additional household income (pay stubs, 1040, etc.)

REQUIRED FOR SPONSORSHIP MATCHING: The following will be posted on the website for donors to see, improving chances of sponsorship.

Student’s first name.
Student's grade K-12
A short bio (aspirations, why cello, or goals)
A smiling face photo of the student.
A video of the student performing on the cello or playing the cello.

Student headshot. (Must be smiling)

Video of the student playing cello

Write a brief bio for the student (aspirations, why cello, goals).

I agree: The student’s photo + grade + first name + bio + video may be posted on the website for donors to see.

I understand sponsorship covers lessons only. Student must provide a cello, accessories, etc...

I understand and agree to the following:

1. Full/partial sponsorships last for 1 year once/if sponsorship starts (subject to funding availability). Students must reapply each year to keep sponsorship. 2. We can end lessons anytime for any reason.

3. We are not liable for injuries, lost items, or travel. 4. Photos/videos of lessons may be shared with donors (faces blurred on request).

5. Submitting false info on this form will result in instant denial + 12 month ban.

I agree to the Attendance & Participation Policy - Attendance & Participation Policy

I have read and agree to Houtz Cello Academy's Terms & Conditions and Privacy Policy

By typing my full name below, I confirm that everything I entered is true to the best of my knowledge and belief

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