Chime Loan Application

Chime Scholarship Application

Today's Date(Required)

Educator's First Name(Required)

Educator's Last Name(Required)

Home Address(Required)

City(Required)

State(Required)

Zip(Required)

Home Phone(Required)

Cell Phone

Personal Email(Required)

School / Institution Name

School / Institution Address

City

State

Zip

School / Institution Phone

School / Institution Email

Principal / Administrator Name & Title

HMA Membership # (if applicable)

Member of HMA for ______ years

1) 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 comments

I hereby apply for a loan of a three-octave set of chimes to be used in the 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(Required)

Date signed(Required)

Please attach proof of insurance (COI)(Required)

I have emailed our Certificate of Insurance to my State Chair.

I have uploaded a copy of our Certificate of Insurance.

UPLOAD Certificate of Insurance

Max. file size: 50 MB.

Name

This field is for validation purposes and should be left unchanged.