DEMOGRAPHIC FORM

DEMOGRAPHIC FORM

"*" indicates required fields

ENROLLED STUDENT/FAMILY DEMOGRAPHIC INFORMATION FORM ALL INFORMATION IS KEPT CONFIDENTIAL

Each participant in this program is required by Broadway School of Music & Arts and the City of Cleveland, Department of Community Development to provide their annual income level to establish eligibility for this federally-funded program, and to verify race/ethnicity for data collection purposes only.

From the income characteristic listed below, please circle the number of persons in your household and the annual income level that matches your household size. Check the appropriate box for race and for ethnicity, when applicable. Sign your name to verify the information you supplied to the Agency is true.

Income Characteristics

Number of Persons in Household*
(Circle One)
Extremely Low Income (0 to 30% of MFI), $
(Circle One)
Very Low Income (31% to 50% of MFI), $
Low Income (51% to 80% of MFI), $
RACIAL CHARACTERISTICS (Check One)
RACIAL CHARACTERISTICS*
ETHNICITY
MM slash DD slash YYYY

Address:

5415 Broadway Avenue
Cleveland, OH 44127

Phone:

(216) 641-0630
TTY/TDD use Ohio Relay Service 1-800-750-0750

Registrar Office and Lesson Hours:

    • Monday, Tuesday, and Thursday 2:00 – 8:00
    • Closing time may change depending on the daily lesson schedule
    • Closed Wednesday, Friday, Saturday, and Sunday
    • Voicemail messages monitored at other times

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Broadway School of Music & the Arts admits students of any race, color, national and ethnic origin, religion, age, or sexual orientation to all the rights, privileges, and programs generally accorded or made available to students at the school. Broadway School is committed to nondiscrimination in the administration of its educational and admissions policies, financial aid and instrument loan programs, and other school-administered programs.