Instructor Billing Form

This form is to be used by music teachers who have students on scholarship with Reading Musical Foundation. Students who have received a need-sensitive scholarship for private music lessons are required to pay the first $5.00 of each lesson (lesson co-pay). Teachers should make arrangements directly with the student/student’s family to collect the copay. Students who have received an audition-based scholarship are not required to pay this copay.

Name(Required)

First Last

Email(Required)

Make Check Payable To:(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Student Name(Required)

First Last

Instrument(Required)

Student Parent Email

Dates of Lessons:(Required)

Total Number of Lessons(Required)

Cost per Lesson (before co-pay, if applicable)(Required)

Is a $5 copay required?:(Required)

Yes

No

Unsure

Total Due from RMF(Required)

Comments

Phone

This field is for validation purposes and should be left unchanged.

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