AGEHR Area I, Inc

Handchime Loaner Application

Educator's Name
School Name
School Address1

School Address2

City, State, Zip
Member Number
Home Phone School Phone
Home Email
School Email
School Fax
Loan Duration:
An entire School Year
First Semester
Second Semester
First trimester
Second Trimester
Third trimester
First and second Trimesters
Second and third Trimesters
from September through June 15
from September through January 15
from January 15 through June 15
from September through November 20
from December 1 through March 15
from March 15 through June 15
from September through March 15
from December 1 through June 15
School Information

a. Describe your school in reference to the grade levels and specific courses that you teach. Please include information on why you believe a handchime program would be well received and beneficial to your students:

b. Describe your school’s schedule. Please include length of period(s), number of times per week you see each class, specific information about any other performance group in your school (chorus, band, orchestra and when they meet for rehearsal.)

c. Describe your school’s student population. Please include average class size, grade level, and special needs populations served by your school:
Assurances and Agreements:
I certify that the statements in the grant application are true, accurate, and complete to the best of my knowledge. If selected, I agree to accept responsibility for the proper care and maintenance of the grant materials. I will assume responsibility for their safe return or replacement, if damaged. In compliance with Area I AGEHR, Inc., and U.S. copyright laws (or applicable copyright laws), I agree not to photocopy any music or printed material provided me through the Handchime Loan Program without express written permission.
Your Signature: 
       Principal's Signature: 

After filling out, please print and send: This form with

  1. Your signature and your principal's signature
  2. Your resume
  3. Your recommendation to:

Griff Gall
277 Shawmut Ave, Unit 1
Boston, MA 02118

For questions please contact the education chair, Griff Gall or phone at (617) 266-0571
*Format and content for the Area I, AGEHR, In. Handchime Loan Program was developed with permission from the Area V Chime Grant Project, the Area VII handbell Grant Project, edited by Dayna Lee Drake, chair, Committee for Handbells and Handchimes in Music Education (CHIME) and the Area I Loan Committee.