MusicLink Registration Form - MusicLink Foundation

MusicLink Registration Form (ML)

This MusicLink Registration Form is for teachers who are not currently registered as MusicLink teachers and who have a student they wish to teach at a reduced fee (50% or more).

1. STUDENT INFORMATION

Name

First

Last

Age

Grade

Date of Birth

Gender

2. PARENT OR GUARDIAN INFORMATION

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

E-Mail

E-Mail 2

3. TEACHER INFORMATION

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

E-Mail

Teaching Experience (Number of Years)

Instruments You Teach

E-Mail 2

You began teaching in what year?

Memberships

Certifications

Education

Background

Do you teach online lessons?

4. LINK INFORMATION

Instrument

Lesson Type

Private
Group
Early Childhood

Would you like us to check the financial eligibility of this family?

If no, please provide some explanation of why you feel this student should be included in the MusicLink program:

5. SCHOLARSHIP INFORMATION

This information is required to assist in establishing the overall scholarship donation of our teachers to the MusicLink program. This information, which is used for statistical purposes, is kept strictly confidential:

Lesson Frequency

Normal fee charged per lesson ($)

Length (minutes)

MusicLink fee charged per lesson ($)

Other Financial Arrangements

6. ADDITIONAL ACTIVITIES

Computer Lab Frequency

Performance Class Frequency

Recital Frequency

Length (minutes)

Other Activities

Should we send our MusicLink newsletter to your student?

7. TEACHER AGREEMENT

I understand that the MusicLink Foundation assumes no legal responsibility for claims arising from this instruction, and I agree to hold harmless MusicLink Foundation from all legal claims in connection with such instruction.

I agree

PLEASE NOTE: The safety of our students is of utmost importance to us, so in volunteering to teach a MusicLink student please understand that you will be asked to submit to a background check at our expense. The MusicLink Foundation is required to obtain background checks on all of its teachers. The information we request to complete the background check will be kept strictly confidential and will be destroyed as soon as the background check is completed.

Our Administrative Assistant will be contacting you regarding a background check. You will receive an email from her personal account (a verizon.net address) with information regarding the background check company (First Advantage). Within 24 hours you will receive an email from First Advantage with a link to access your background check form. Your name and email address will already be in the system, but you will need to complete the balance of the form including your address, birthdate, social security number, etc. Upon submission of the form your background check will be completed and our Administrative Assistant will be notified regarding your status. The First Advantage system is secure, and no one (including MusicLink staff) will have access to our personal information.

If you have any questions or concerns, contact us at info@musiclinkfoundation.org.