Harmony Application (English) 2021-2022 Harmony Application English Student Application for 2021-2022 Harmony ProgramPlease fill out the information below to apply to Harmony for the 2021-2022 academic year. The Harmony violin program is now full and new interested students will be put on a waitlist. The Harmony cello program still has a limited number of spots remaining, sign up today! The Harmony has a limited number of spots and will be accepting students on a rolling basis. At this time 2nd and 3rd graders are prioritized for program acceptance and 4th graders may be accepted if we have additional spots. If your student is in 4th grade we will be in touch about whether they are accepted after you complete the application. Once we reach capacity, we will begin a waitlist. At this time there are still open spots! Student Name* First Last Has your student played in Harmony before?*YesNoGrade in 2020-21:*Please list the grade your student will be in during the 2021-22 school year. Grade2345 Attention 5th Grade Families We are not accepting first year 5th grade students at this time. What instrument is your student interested in?*ViolinCelloUndecidedStudent age* Select student race*We collect confidential information about students’ race to help inform our programming, report to philanthropic funders who request it, and measure progress toward GTCYS’ diversity and equity goals. For this particular purpose, please select the category with which you most closely identify. We understand that many students may identify with more than one race. If you are more comfortable, please select “other” and describe your race(s). Thank you. White or Caucasian Black or African American Hispanic or Latinx Asian or Asian American Native American If you would like to provide any other details about your student's race, please enter it here: Student birth date:*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Select your gender*FemaleMaleNonbinaryTransgenderPrefer not to saySelect your pronouns:* He/him She/her They/them Who is your student's classroom teacher?*Ms. WandaMrs. PabonMs. WeningerMs. AndreMs. JohnsonMrs. KelloggMs. ArroyoMrs. RodriguezMs. Brunzell LooneyMs. MMs. NelsonNot sureOtherOther Parent/Guardian DetailsParent/Guardian 1 Name* First Last Parent/Guardian 1 Phone*Parent/Guardian 1 Email*Harmony will be using email as a primary mode of communication with you. Please enter an email that you regularly check. Enter Email Confirm Email Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Does the student live with two Parents/Guardians?Clicking yes will allow you to complete information for Parent/Guardian 2.YesNoParent/Guardian 2 Name First Last Parent/Guardian 2 PhoneParent/Guardian 2 EmailHarmony will be using email as a primary mode of communication with you. Please enter an email that you regularly check. Enter Email Confirm Email Emergency Contact*Please enter a contact who is different from your parent/guardian 1 and 2. First Last Emergency Contact Phone number*Student AllergiesIf none, then please write N/A. Behavioral or Medical ConditionsWe collect this information to help our teachers better understand their students and provide the best classroom experience possible. Everything shared in this field will remain confidential.TransportationWe are still uncertain if the district will be able to provide bussing to Harmony this year. Please answer the following questions about your transportation needs so we can do our best to find a transportation solution for you. If bussing were not available this year, would a member of your household or another individual be able to drive your student to Harmony in the mornings?*(Program begins at 8:00am sharp, students are expected to arrive at 7:50am on Tuesdays, Wednesdays, and Thursdays) Yes, I or someone I know will be able to driveUncertain - I will have to look at my optionsNo, that is not possible for my familyGreat! Would you be willing to be a driver for a carpool to help more students be able to participate in Harmony this year?Clicking yes does not mean that you will definitely be a carpool driver – it indicates that you are willing to be put on a list of individuals who are willing to drive if there is a need. If there is a student who lives nearby you who indicates a need, we will be in contact with you.YesNoWould you be interested in connecting with other families who have offered to be carpool drivers in the mornings?YesNoThird ChoiceOther information about your studentIs your child an English learner? What language do you speak at home? Student Interest*Learning to play a musical instrument is fun and rewarding, but also requires hard work. Tell us why you want to play a musical instrument. (You may ask your child this, and write down their response here).Parent Commitment*Parental success and involvement is also important in a child's success in learning a musical instrument. Please tell us why you would like to see your child participate in Harmony, and how you will support his/her musical education (practice at home, take care of instrument, attend concerts, volunteer, etc.)Next Step: Harmony recommended participation fee Select ‘Submit’ below and follow the instructions on the Harmony recommended participation fee. If you are unable to pay the fee at this time, you may specify this on the following page. If you exit this page without clicking 'Submit,' your information will be lost. Thank you! EmailThis field is for validation purposes and should be left unchanged.