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MODE MUSIC STUDIOS SCHOLARSHIP REGISTRATION FORM
Mode Music Studios
3805 Delridge Way SW
Seattle WA 98106
http://www.modemusicstudios.com
We are pleased to offer financial assistance to students and families in need. Please fill out the following in its entirety to be considered.
STUDENT & SIBLING INFORMATION
STUDENT 1 First Name
*
Last Name
*
Gender
*
Male
Female
Non-Binary
Prefer not to answer
Preferred Pronouns
*
he/him
she/her
they/them
Prefer not to answer
Birth Date
*
+
Does the student have any medical, learning, behavioral or other special considerations / circumstances of which the school should be aware? (Please explain):
*
0/200 characters
STUDENT 2 Last Name
First Name
Gender
Male
Female
Non-Binary
Prefer not to answer
Preferred Pronouns
he/him
she/her
they/them
Prefer not to answer
Birth Date
+
Does the student have any medical, learning, behavioral or other special considerations / circumstances of which the school should be aware? (Please explain):
0/200 characters
STUDENT 3 First Name
Last Name
Gender
Male
Female
Non-Binary
Prefer not to answer
Preferred Pronouns
he/him
she/her
they/them
Prefer not to answer
Birth Date
+
Does the student have any medical, learning, behavioral or other special considerations / circumstances of which the school should be aware? (Please explain):
0/200 characters
What instrument is the student interested in learning?
*
Is there any other information that you'd like us to know? (Please explain)
*
0/200 characters