SMI Application

Application for Admission
136 Market Square Cartersville, GA 30120

770-871-9258

www.southeastmusicinstitute.com
Southeast Music Institute is committed to being a welcoming and diverse community of students, faculty, and staff. SMI admits qualified students to its program of study regardless of age, color, gender, sexual orientation or preference, national or ethnic origin, or disability. SMI does not discriminate on the bases of any of these in the administration of its educational priorities, admissions policies, bursaries, or programs administered.
Personal Information
Full Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Birth

MonthDayYear
Date
Instrument(s) played
Citizenship
Emergency Contact Name
Relationship
Emergency Contact Phone Number
Please enter a valid phone number.
Emergency Contact Email
example@example.com
Give details of your educational background, showing schools, universities attended and degrees or diplomas received or in progress.
Vocational Background (including relevant volunteer experience).
Employer
Address
Start Date

MonthDayYear
Date
End Date (use today's date if current)

MonthDayYear
Date
Type of Work
Position Held
Employer
Address
Start Date

MonthDayYear
Date
End Date (use today's date if current)

MonthDayYear
Date
Type of Work
Position Held
If you have undertaken any specialized or professional training, please indicate below
Three reference letters are required from persons familiar with your academic and musical abilities. One letter of three should come from an individual familiar with your musical ability. All letters must be sent directly to SMI by mail or scanned and emailed to southeastmusicinstitute@gmail.com.
Reference #1- Name
Reference #1- Phone Number
Reference #1- Occupation
Reference #1- Relationship
Reference #2- Name
Reference #2- Phone Number
Reference #2- Occupation
Reference #2- Relationship
Reference #3- Name
Reference #3- Phone Number
Reference #3- Occupation
Reference #3- Relationship
Applicants whose first language is not English must provide evidence that they can read, write, and speak in English at a graduate level.
Students must be at least 18 years of age, hold a valid driver's license, and be a U.S. citizen (or hold a current work visa).
How did you hear about SMI? Please check all relevant options and provide some further information in the space provided.

WebsitePosterSchoolWord of MouthPrint Media (newspapers, magazines, handouts, etc.)Other
Please note that there is a non-refundable $150.00 application fee which needs to be paid before your application will be considered for admission.
If accepted to Southeast Music Institute, I intend to be a responsible and participating member of the SMI community, abide by the policies of the institution, and pay all tuition and fees applicable to my program of study.
Signature of Applicant

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Date of Signature

MonthDayYear
Date
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Application for Admission

Personal Information