Chapter One Assistance Fund Application Form

Greater Cleveland Chapter One, American Orff-Schulwerk Association
-- Music & Movement Education

Chapter One Assistance Fund Application Form
-- To The Applicant:

1)	Fill out and sign this form. Please type or print clearly.
2)	Hve two persons submit references on the form provided: One person should be able to comment on your work as a teacher (or as a college student). The other may be a person not associated with your professional life.
3)	Return form to: Chapter One Assistance Fund, c/o Alan Purdum, 128 Fairview, Cortland, OH 44410-1426. Applications must be postmarked no later than March 15.

Name of Applicant: _________________________________________________________________________

Phone (Day): _ Phone (Evening): __

Address:

_________________________________________________________________________________

_________________________________________________________________________________

Present Teaching Position (If Any):

____________________________________________________________

____________________________________________________________

Highest Degree Attained (In Music Education):

____________________________________________________

Orff-Schulwerk Training Courses Completed:

_____________________________________________________

_____________________________________________________

Amount Of Award Sought:

_____________________________________________________________________

Purpose For Which Award Would Be Used:

________________________________________________________

________________________________________________________

Tell Why You Need Assistance To Accomplish This Goal:

____________________________________________

___________________________________________________________________________________________

Are You Applying For Any Other Assistance? If Yes, Please Explain:

___________________________________

___________________________________________________________________________________________

Please Read and Sign:

I affirm the information given on this form is true. I understand that if I receive an award it shall only be used for the purpose(s) stated herein. I also understand that any award obtained through falsification of facts, or any award not used for its intended purpose must be repaid to the Chapter One Assistance Fund by the recipient.

Signed, ____________________ Date:

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Greater Cleveland Chapter One, American Orff-Schulwerk Association-- Music & Movement Education Chapter One Assistance Fund Application Form-- To The Applicant:

Name of Applicant: _________________________________________________________________________

Phone (Day): _______________________________ Phone (Evening): ________________________________

Please Read and Sign:

Signed, ________________________________________ Date: ____________________

Press The Print Button On Your Browser To Print This Form Page To Return To Assistance Fund Page, Click Your Browsers Back Button OR, Click Here To Return To Cleveland Chapter Home Page

Greater Cleveland Chapter One, American Orff-Schulwerk Association
-- Music & Movement Education

Chapter One Assistance Fund Application Form
-- To The Applicant:

Phone (Day): _ Phone (Evening): __

Signed, ____________________ Date:

Press The Print Button On Your Browser To Print This Form Page
To Return To Assistance Fund Page, Click Your Browsers Back Button
OR, Click Here To Return To Cleveland Chapter Home Page