SHROPSHIRE MUSIC SERVICE
Longmeadow
Bayston Hill
Shrewsbury
SY3 0NU
REQUEST FOR REFUND OF REMISSIONS PAID TO STUDENTS
Term claiming for
Autumn
Spring
Summer
(Please circle)
(Please send one form per term, at the end of the term)
I would like to request a refund to recompense my school for the costs incurred in providing a remission on fees for
instrumental lessons and instrument hire.
Shropshire Music Service are committed to supporting students on lower incomes up to £90.00 (per term) for those
receiving income support or child tax credits, providing they are not entitled to working tax credits and have an annual
family income less than £16,010, or Children Looked After, or to 25% of the fees for those on Working Tax Credits.
(please see application for remission of fees for 2016/2017 for more details.
I understand the refund per student will be limited to the lower amount of either the charge which would have been
made for the lesson or the amount SMS would have charged had the lesson been directly invoiced.
The Music Service are able to process remission claims for those in receipt of free school meals or who are looked
after without proof of benefit. Therefore please only send a copy of the benefit documentation for those applying
for a 25% remission. The refund of remission will not be processed without this information as we are no longer
able to check on our system.
Name of
Music Teacher/
School:
Head Teacher:
Cost
Subjective
Centre:
Code:
Student Name
Charge made by School
Charge for
Instrument
Lesson/Term Hire/Term
Equivalent SMS Charge
Charge for
Instrument
Lesson/Term
Hire/Term
£90.00
£8.50, £15.00 or
£20.00
Amount of
Refund Due
Total Cost of Hire/Term
Current Fee Level for Shropshire Music Service
Standard Group Lessons:
£90.00/term (£270.00/annum) for 34 lessons of 20 minutes duration, please request information for charges on non
standard lessons.
Instrument Hire
Cello/Flute/Clarinet/Saxophone/Cornet/Trumpet/Trombone/Snare Drum: £20 per instrument per term, £10 per half
term.
Bass/Oboe/Bassoon/Horn/Euphonium/Baritone/Tuba/Viola: £15 per instrument per term, £7.50 per half term.
Violin/Ukulele/Guitar £8.50 per term, £4.25 per half term.
Headteacher’s Signature:
Name:
2016-2017
Date:
SMS RRF