MODE MUSIC STUDIOS SCHOLARSHIP REGISTRATION FORM 2020-2021 ACADEMIC YEAR

Mode Music Studios
3805 Delridge Way SW

Seattle WA 98106
http://www.modemusicstudios.com

This year, we are pleased to offer financial assistance to families in need for the 2020-2021 school year. Please
fill out the following in its entirety to be considered.

STUDENT & SIBLING INFORMATION

STUDENT 1 First Name *

Last Name *

Gender *

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

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

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