AIPS form

Assisted Instrument Purchase Scheme

Pupil’s details

Pupil’s Name *

The instrument is for… *

Pupil’s tuition at a local authority school

Pupil’s tuition at a Music Centre or Gwent Ensemble

School name *

Music Centre or Gwent Ensemble attended *

Gwent Music instrumental tutor’s name *

Payer’s details

Name *

Address (including post code) *

Contact number *

Email address *

Instrument required

Instrument (e.g. flute) *

Make / Model (if known)

Supplier (if known)

If you have already selected an instrument from a specific supplier, or have the instrument on approval, please enter their name here. In this case we will not ask for competitive quotes and will assume that you have satisfied yourself that you are getting best value for money from the supplier you have selected. Your child’s tutor will still be contacted to ensure the instrument is suitable, as per the terms of this scheme.

Cost excluding VAT (if known)

If you are human, leave this field blank.