Name_________________________________________________ Date___________________
Address______________________________________________________________________
City_______________________________________________State_______ Zip____________
Phone__________________________________ E-mail________________________________
High School___________________________________________________________________
Year in which you expect to enter college_____________

Program you wish to enter
_____ Music Education
_____ Music with a concentration in performance
_____ Music with a concentration in church music

Your major performance area (voice, flute, etc.)_______________________________________
Years of private instruction in your major performance area______________________________
Secondary area(s) in which you also perform__________________________________________
Number of years you have participated in the following groups:

_____ High School Choir (voice part)____________________
_____ High School Band
_____ High School Orchestra
_____ District (or State) Chorus
_____ District (or State) Band
_____ District (or State) Orchestra
_____ Church Choir
_____ (Other)_____________________________________

Amount of instruction you have had in music theory____________________________________

Individuals who can evaluate your experience and ability in music:

Name________________________________ Name________________________________
Street________________________________ Street________________________________
City________________ State____ Zip______ City_______________ State____ Zip_______
Phone number__________________________ Phone number_________________________