ProMusica Scholarship Registration Form

All fields in bold are required.

*
First name
Middle name
*
Last name
Preferred name
*
Street Address
*
City
*
State
*
Zip/Postal Code
* Home Phone
(xxx-xxx-xxxx)
*
Email
*
I will be a … Freshman
Transfer

If transfer, list last college attended:
*
Term of Anticipated Enrollment Fall
Spring


Year
*
I am auditioning for:
Check all that apply.
Voice
Piano  
Instrument

If instrumental, please indicate what instrument:
*
Academic Program 1
Academic Program 2
*
High School Name
*
High School City
*
High School State
*
High School Graduation Date
*
Number of guests coming with you: