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Prospective Student-Musician Questionnaire
Prospective Student-Musician Questionnaire
Student First Name:
*
Student Last Name:
*
Sex:
*
Male
Female
Applying for Grade:
*
9
10
11
12
PG
Date of Entry:
*
Fall 2011
Fall 2012
Parent names:
Please enter the names of the student's parents
Home Address
Street Address:
*
Apt. No., Box No., etc:
City, State, zip (postal code):
*
Phone Number:
*
E-Mail:
*
Date of Birth:
*
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Are you applying for financial aid?:
no
yes
Current School:
*
How did you first learn about NMH?:
*
- Select -
Educational Consultant
Guidance Counselor
School Fair
School Music Teacher
Private Music Teacher
Publication
Other Web Site
Web Search Engine
Relative(s) Attended NMH
NMH Alumni
NMH Faculty
Current NMH Family
Reputation
School Visit by NMH
Placement Organization
Summer Programs
Visited the Area
Other
Please list interests in order of priority
Instrument/Voice #1:
Years of Study:
Ensembles with this instrument/voice:
School Music Teacher:
School Music Teacher's Phone Number:
Private Music Teacher:
Private Music Teacher's Phone Number :
Instrument/Voice #2:
Years of Study:
Ensembles with this instrument/voice:
School Music Teacher:
School Music Teacher's Phone Number:
Private Music Teacher:
Private Music Teacher's Phone Number :
Instrument/Voice #3:
Years of Study:
Ensembles with this instrument/voice:
School Music Teacher:
School Music Teacher's Phone Number:
Private Music Teacher:
Private Music Teacher's Phone Number :
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