Chime Scholarship Application Today's Date(Required) MM slash DD slash YYYY Educator's First Name(Required)Educator's Last Name(Required)Home Address(Required)City(Required)State(Required)AlabamaArkansasLouisianaMississippiTennesseeZip(Required)Home Phone(Required)Cell PhonePersonal Email(Required)Section BreakSchool / Institution NameSchool / Institution AddressCityStateAlabamaArkansasLouisianaMississippiTennesseeZipSchool / Institution PhoneSchool / Institution Email Principal / Administrator Name & TitleHMA Membership # (if applicable)Member of HMA for ______ yearsSection Break1) Give a brief summary of your musical and education experience. Please list any handbell or chime experience as well.(Required)2) Describe the educational institution where the chimes will be utilized (grade, age, special needs, etc.)(Required)3) Describe how you hope to incorporate chimes into your curriculum.(Required)Any additional commentsI hereby apply for a loan of a three-octave set of chimes to be used in teh above school / institution from (start date to end date)(Required)I will use the chimes in a minimum of two programs within the dates allotted.(Required) YES I am willing to write an article about how the chimes were utilized for the Area 6 website.(Required) YES Applicant Signature (a formal signature will be required later)(Required)Date signed(Required) Month Day Year Please attach proof of insurance (COI)(Required) I have emailed our Certificate of Insurance to my State Chair. CommentsThis field is for validation purposes and should be left unchanged.
