Drum Power Application Form Items in white are required to submit form. Organization Name Program Site Address Main Contact Name Phone Mailing Address Fax Program Information Proposed Program Start Date Proposed Program End Date Sessions Would Start at the Following Time of Day Sessions Would End at the Following Time of Day Number of Youth Participants Age of Participants (Check All that Apply) 8 to 9 yrs. 10-12 yrs. 13-14 yrs. 15-18 yrs. Which Days of the Week Would You Offer the Program? How long would each session be (hours)? List the staff from your organization that would be involved in helping design and implement your project : Name & Title Phone Fax Facilities & Equipment Does your organization have drums? Yes No If Yes, Describe Drums: Do you plan to: Purchase Drums Rent Drums Neither Please describe the Room that you plan to use for the program below in terms of the following: Size & number of people it accommodates Number of windows Is there a secure storage space for drums (min. 3 ft. x 4 ft.)? Yes No Where is the room located in relation to other rooms (given loudness of drums)? Program Goals Explain what you hope youth will gain from participating in the program: Pick the 4(FOUR) most important OUTCOMES that are most important for your program and list: When will youth have the opportunity to perform? Event/Location Date Time