Jazz Camp Scholarship Application This is a secure page. All submitted information is encrypted for your security. Step 1 of 3 33% Student InformationStudent Name* First Last Birth Date*Gender* Male Female Student Address* Street Address City ZIP / Postal Code Student PhoneStudent EmailWe primarily contact all applicants and parents by email. If you do not have an email address that you check regularly please indicate in the notes the best way for us to contact you. Instrument*If multiple instruments, please list instruments in order of preference to be played at camp. Note: drum section fills quickly so additional instrument choices might be considered.Years Played*Is the student currently in a school music program?* Yes No Current Band Director / Choir InstructorBand Director - phone or emailDoes the student have a private music instructor?* Yes No Private InstructorPrivate Instructor - phone or emailSchool Enrolling entering Fall 2016*Grade entering Fall 2016*8th grade9th grade10th grade11th grade12th gradeother Parent/Guardian InformationParent/Guardian Name* First Last Is the parent's address the same as the student's?* Yes No Parent/Guardian Address* Street Address City ZIP Code Parent Phone*EmailWe primarily contact all applicants and parents by e-mail. If you do not have an e-mail address that you check regularly please indicate in the notes the best way for us to contact you. Emergency ContactEmergency Contact's Name* First Last Emergency Phone*Relationship to camper*Financial InformationYou may also complete, print and mail this form to: Kuumbwa Jazz, 320-2 Cedar Street, Santa Cruz, Ca 95060. Call if you have questions, 831-427-2227 Has camper ever received a scholarship from KJC?* Yes No Total number of family members in home:*Total family gross annual income:*Estimate of what I can pay towards fee:*Please Note: This year, most scholarship recipients will be required to pay a minimum of $150.How will you pay for the tuition if a balance is due?* Credit Card (Master Card or Visa only) Check Credit Card NumberWe will notify you on the status of the scholarship application before any charges are run on the card.Exp Date Student EssayPlease have the student write a 200 word essay for the scholarhship panel to review. The topic is listed below, thank you. Please tell us why you are interested in attending the Kuumbwa Jazz Camp. What do you hope to learn and achieve? What special quality do you have that will contribute to the positive learning environment of Jazz Camp? Tell us how long you’ve been playing and where you do most of your playing, such as in school band, church, with family, on your own, or any other environment.This portion can be emailed to firstname.lastname@example.org or faxed to 831.427.3342How did you hear about the camp?*Select OneKuumbwa EmailSchool Music TeacherPrivate Music TeacherFamily MemberPast CamperNewspaper AdKuumbwa WebsiteOtherDo you have more to add? Let us know here!Please Take Note:If you do not receive a confirmation email after submitting, please call the office at (831) 427-2227. **Remember to check your email's spam folder for the confirmation!**Photographs*Kuumbwa Jazz reserves the right to photograph students during jazz camp and use certain images for future promotional material. Please contact the office directly if you have questions. I have read this and understand. CommentsThis field is for validation purposes and should be left unchanged.