Full Name of Person Completing This Application*

Full Name/s and Age(s) of Student(s)*

Address*

City, State and Zip Code*

Home Phone*

Cell Phone*

Your Email*

About the Student(s)* | Tell us a little about the student(s) who will benefit from this award, including musical history and background, favorite hobbies and activities, developmental or physical challenges, where they attend school, etc.

Total Household Income* (include all types of income, e.g., wages, tips, child support, SSI, federal aid, disability, rental property income, etc.)

Number of Household Members* (individuals supported by the income above, as indicated on your tax return)

Financial Overview* | Please include employment status, occupations, employers, etc. for all adults in the household, as well as any unique financial obstacles you are facing, such as medical expenses, job loss, etc.

Please write a brief statement of need including any other information you think would be useful.* (Our standard financial aid assistance is a discount of 30%-50%. This year we are asking families to let us know if this discount is not adequate to meet their needs. We will re-evaluate based on the availability of funds.)

Supporting Documentation | Please mail your most recently filed tax return to Portland Conservatory of Music, 202 Woodford Street, Portland, ME 04103. If it does not accurately reflect your current financial situation, please explain any recent changes.
If you have not filed taxes in the past 2 years, please indicate that below and supply PCM with copies of any documents that substantiate your need (qualification letters for SSI, disability benefits, federal assistance, etc.

If you have any questions, do not hesitate to contact PCM's Executive Director, Jean Murachanian at 207-775-3356.