Information Request Form

Last/Family name:

First:

Middle/Initial:

Email address:

Current Address:

City:

State/Province:

Zip/Postal Code:

Country:

If not U.S., list country:

Are you a U.S. citizen or permanent resident?

Phone Number (please include the area code):

Fax Number:

High School/College most recently attended:

Current Year in School:

Primary Instrument:

Secondary Instrument:

Term you wish to enroll:

Check Programs of Study in which you are interested:

Bachelor of Arts:
Traditional Program

Bachelor of Science in Music:
Music Technology Emphasis
Business Emphasis

Bachelor of Science in Education:
Vocal Emphasis
Instrumental Emphasis

Option with any of the above degrees:
Performance Emphasis

ACT or SAT Score (if not taken yet, enter "99"):

Class Size:

Class Rank:

Comments: