Student's Name *

First Name

Last Name

Students Date of Birth *

MM

DD

YYYY

Parent, Guardian, or Caregiver Information *

If you are an adult seeking tuition assistance for an adult group class, please enter "self" for the first and last name, then provide your email and phone number below

First Name

Last Name

Caregiver Phone Number *

(###)

###

####

To which program will tuition assistance be applied? *

Note: Tuition assistance at Omaha Girls Rock includes Gear Loan for the semester.

30-min lesson Instrument Instruction

60-min lesson Instrument Instruction

Gear Loan

How much can you pay toward tuition? *

75% of the total tuition

50% of the total tuition

25% of the total tuition

$0 - I am requesting 100% tuition assistance

Would you be interested in providing volunteer service for OGR in exchange for partial tuition assistance?

If yes, select all that you're open to

Representing OGR at a community event

Providing behind-the-scenes support at a showcase

Providing behind-the-scenes support during summer camp

Administrative and/or business support TBD

Moving instruments and gear

Hosting a friend-raising or get-to-know-you event for OGR

No, I'm not interested

Other