Student for a Day Request Form

Date Requested for Visit - Visits are not available on Fridays *

Month

Day

Year

First Name: *

Middle Name: *

Last Name: *

Preferred Name *

Pronouns *

Student Email Address: *

Student Mailing Address: *

City: *

State: *

Zip Code: *

Student Cell Phone: *

Parent/Guardian Name *

Parent/Guardian Email address *

Parent/Guardian Cell Phone *

Home Phone: *

Name of parent/guardian who will accompany you to your visit (Required) if under 18 years of age

Accompanying parent/guardian Cell Phone Number (if different from above)

Accompanying parent / guardian email address (if different from above)

Primary Instrument *

Secondary Instrument *

Intended Major: *

Current Grade Level: *

Junior

Senior

Transfer from community college

Transfer from 4-yr school

High School or College Attending: *

Name of Band/Orchestra/Choir Director: *

Band/Orchestra/Choir Director Email Address: *

Have you studied privately? *

Yes

No

Private Teacher Email Address

Please list each instrument/voice studied privately, number of years studied, and name(s) of teacher(s): *

Please list the solo or chamber literature you have studied on your instrument/voice

Please list the ensembles in which you regularly perform: *

Please list any honor ensembles in which you have participated and years of participation: *

e.g. all-county, all-district, all-state, etc.

Have you attended Cannon Music Camp? If so, please list the years of attendance

Please list any non-musical awards you have received or activities in which you have been involved: *

What is your current weighted high school GPA or current college GPA (if transfer student)? *

Other Information:

Hayes School of Music