Date:  ____________________

Name:  ______________________________________________________________________

Address (street, city, state, zip):  ___________________________________________________

Guardian Name:  _______________________________________________________________

E-mail address:  _____________________________________________

Telephone (w/Area Code):  __________________________

Please circle one:        Music Major        Music Minor        Music Elective

High School Grade Point Average (GPA):  _____________    ACT Score:  ______________

Major Instrument / Vocal Classification:  _____________________________________________

Name of Private Teacher (if applicable):  _____________________________________________

Do you play piano?  _____________

If not a piano major, name a piano composition you could play:  ____________________________

List other instruments, if any, that you play:  ___________________________________________

Describe any music theory background you may have had:


Describe your performance experience (high school, church, contests, musicals, etc.):


Name of music composition(s) you will perform:

Composition Title: Composer:
___________________________ ___________________________
___________________________ ___________________________

Name of high school and music director:

Name of church and music minister:

On a separate sheet of paper, briefly describe what you hope to do with your music degree if you are a music major or minor.