Pathways Student Application

Student Information
Student Name*
Student Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
- Male
- Female
- Other
Student Mailing Address*
Student Email
Student Cell Phone
RCSD School*
RCSD Music Teacher*
Student Grade Level in Fall 2020*
Instrument or Voice Type*
Student Agreement
As a Pathways student, I would agree to: notify teachers in advance of any absences; attend weekly lessons or chorus on time; always bring my music and instrument; practice daily; attend all my Pathways ensemble or choral concerts. If I take private lessons, I will agree to: perform in at least one ECMS recital; participate in the annual NYSSMA or MCSMA solo festival; participate in my school music ensemble on the instrument or voice being studied at Eastman; fulfill the expectations of the private teacher at Eastman; perform an annual performance jury at Eastman; participate in the annual Citywide RCSD concert. I understand that Pathways will request grade reports, and have access to my academic standing through the RCSD. NOTE: Attendance is very important to your success in the Pathways Program. Students with multiple unexcused absences will be asked to give up their scholarship. Please see the Student Handbook for more details!
Student Electronic Signature*
Type the Date*

Guardian Information
Write N/A for not applicable or leave blank. **IMPORTANT**: Parent and student emails will be a primary form of contact. Please provide your primary email addresses and check your email regularly!
Parent/Guardian Name*
Relationship to Applicant*
Parent/Guardian Mailing Address*
Parent Email*
Parent Cell Phone*
Parent/Guardian Occupation*
Parent/Guardian Employer
Please list Name/Phone/Relation to applicant of additional parent/guardian(s)

Financial Information
This section MUST be complete for us to process your application. You will need a copy of Page 1 of your IRS form (1040, 1040A, or 1040EZ) FROM THE MOST RECENT TAX YEAR to complete this section. You will also need a scan or a photo of this form to submit.
Tax Filing Status*
- Single
- Married
- Married, but filing separately (You must include IRS form from BOTH spouses)
Family Adjusted Gross Income*
Number of People in Family*
Page 1 of IRS Form (1040, 1040A, 1040EZ) from the MOST RECENT tax year*
- I will submit a hard copy of the form to the ECMS office (10 Gibbs Street)
- I will upload a scan/photo of the form with this application
- I will email a scan/photo of the form to eastmanpathways@esm.rochester.edu
We cannot accept tax forms from years past. We must have your most up-to-date information for your 2019 taxes.
File Upload: Page 1 of 1040, 1040A, 1040EZ)
Accepted file types: jpg, pdf, gif, png, doc.
Please CROSS OUT your SOCIAL SECURITY number for security purposes.
Please explain any additional reasons why your family may need financial assistance:

Parent Agreement
I support my child’s participation in the Eastman Pathways Community Music School Scholarship Program. All accepted students will be required to attend the mandatory orientation session in June, at the Eastman School of Music’s Kilbourn Hall. Students are required to attend with their parent or guardian. Scholarship recipients will be asked to complete a registration form and pay an annual registration fee; this fee is due at the orientation session. Students will be expected to have regular access to an appropriate instrument for practice. Most importantly, parents agree to facilitate transportation to and from the Eastman School of Music for attendance at weekly lessons, chorus, classes, and recitals. I understand that Pathways will request grade reports, and have access to my child's academic standing through the RCSD.
In place of a written signature, type your full legal name:*

Student Information