Musical Moments Trust Scholarship Form

To submit an application, please fill in below. Remember, it is better to be as detailed as possible to give yourself the best chance!

GENERAL INFORMATION

What is the Musical Moments Trust?
The Musical Moments Trust scholarship is offered to pre-school and primary school aged children living with cancer, to fund positive musical experiences for they as they move through their treatment and beyond. Past recipients have enjoyed private and group music lessons, home visits from a music therapist, musical instruments and the chance to create and record a song with a musician.

Who can apply?
To apply for the Musical Moments Trust scholarship, the applicant must:
– Be a Challenge member who has been diagnosed with cancer or a life-threatening blood disorder
– Be aged between 0 and 12 years inclusive
– Not have previously been awarded the Musical Moments Trust Scholarship.

You can continue to apply for this scholarship until the applicant no longer meets the criteria.

CONFIDENTIALITY
All information contained within this application will remain strictly confidential.
Personal Information
Applicant Name*
First Last
Date of Birth*
DD slash MM slash YYYY
Gender
Primary Address*
Street Address Address Line 2 Suburb State / Province / Region ZIP / Postal Code Country
Contact Email
Does your family primarily speak a language other than English in the home? If yes, what language do you speak?

Personal Information