Sponsoring Institution Application -

MENTORING INSTITUTION INFORMATION

Institution Name(Required)

Institution Address(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Institution Phone #(Required)

Institution Website URL

Contact Person for this application(Required)

Contact Person's Job title(Required)

Contact Person's Phone(Required)

Contact Person's Email(Required)

Proposed dates of Internship(Required)

Grants are ten months in length.

Concisely stated, what distinguishes your institution as a whole?(Required)

MUSIC DEPARTMENT

Music Staff(Required)

List all music staff and their job titles. Add additional rows by pressing the + on the right.

Choirs & Rehearsal Schedule(Required)

List each choir in a separate row (use the + on the right to add a row), indicating its rehearsal schedule and which staff person is responsible for it.

Occasional Services(Required)

List all occasional services (and specify frequency) for which each staff member is responsible. (Use the + on the right to make a row for each service.)

Concerts & Recitals(Required)

Please list type and frequency. (Use the + on the right to add new lines.)

Rehearsal Facilities & Instruments(Required)

Please briefly describe your worship and rehearsal facilities, including available instruments.

Concisely stated, what distinguishes your music program from others?(Required)

INSTITUTION'S MENTORING COMMITMENT

What will your intern's duties be? (Please be specific.)(Required)

Who will your intern's principal mentor be?(Required)

How will the principal mentor interact with the intern?(Required)

Please be specific, enumerating both active and passive means by which you intend to mentor an intern.

List any secondary mentors (names & job titles)

List each secondary mentor/title on a separate line. Use the + on the right to add lines.

How will the secondary mentors interact with the intern?

Please be specific, enumerating both active and passive means by which you intend to mentor an intern.

FINANCIAL INFORMATION

Institution's Legal Name(Required)

Institution's Tax ID#(Required)

Annual Institutional operating budget(Required)

Annual Music department budget(Required)

Please give details regarding the financial commitment your institution commits to make to the AAM Gerre Hancock Fellow, should your church be designated the site of the Internship.

Salary(Required)

Do not include the $16,000 AAM grant in the salary number you give. Your institution’s contribution to salary must be at least $16,000 to match the amount provided by the AAM.

Housing(Required)

Healthcare Provider(Required)

Healthcare Coverage Type(Required)

Monthly cost of policy(Required)

% of premium you pay(Required)

List any other financial support to be given (if any)

CERTIFICATION

By submitting this application, I attest that I have read and understand the terms and conditions of institutional participation in the AAM Gerre Hancock Internship Grant as set forth in the AAM Gerre Hancock Internship Grant: Policies, Guidelines, and Procedures. I certify that I am entitled to sign on behalf of my institution and that my institution will abide by the aforementioned terms and conditions. I realize that failure to do so would result in immediate termination of the grant.

In lieu of a signature, please give your name, title, and date below.

Name of person certifying this application(Required)

Job Title(Required)

Date(Required)

Comments

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

Sponsoring Institution Application for the AAM Gerre Hancock Internship

MENTORING INSTITUTION INFORMATION

MUSIC DEPARTMENT

INSTITUTION'S MENTORING COMMITMENT

FINANCIAL INFORMATION

CERTIFICATION