GET ASSISTANCE

To request financial assistance from the Southern Appalachia Musician Fund, please fill out the form below. Please allow us time to review your application with our committee. If your situation is an emergency, please ALSO contact us HERE.

Name

First Name

Last Name

Stage/Artist Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Website

Line

Describe your role in the music industry

(e.g., performer, songwriter, producer, engineer, etc.):

Describe your recent work on projects in the music industry

(e.g., number of shows, studio work, collaborations):

Line

Current average household monthly income:

Percentage of monthly income derived from your music career:

Average total monthly expenses:

Please describe the nature of your current crisis

(e.g., medical emergency, equipment theft or loss, job loss, other):

Total amount of financial assistance requested:

Date funds are needed by:

Line

Reference #1

First Name

Last Name

Phone

(###)

###

####

Reference #2

First Name

Last Name

Phone

(###)

###

####