Application: 2024 Ukiah International Music Academy
Welcome! We are looking forward to getting to know you through your application.
Applicant Information
Name
*
First Name
Middle Name
Last Name
Preferred Name
Sex
*
Please Select
Female
Male
Gender Identity
MISMA is committed to inclusion, non-discrimination and creating a safe environment for everyone in our community.
Personal Pronouns
Birth Date
*
-
Month
-
Day
Year
Citizenship
*
US Citizen or Permanent Resident
Please Select
I am a US citizen
I am a permanent resident of US
Email Address
*
example@example.com
Phone Number
*
Which program are you applying to?
*
Please Select
Guitar
Saxophone
Harmony Children
Your preferred dates to attend the program
*
Please Select
06/16 - 06/22 (one week)
06/23 - 06/30 (one week)
06/16 - 06/30 (two weeks)
07/21 - 07/31 (10 days)
Address
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Parent or Guardian 1
For minors under the age of 18.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Relationship to Applicant
Education
If you are a student enrolled in a school or music program, please provide the information requested in this section.
Name of Your Current School
Current Grade Level
Name of Your Primary Instrument Teacher
Short Essays
The recommended essay length is 150-300 words.
Why do you wish to attend the Ukiah International Summer Music Academy?
*
Tell us about your music journey. (You are encouraged to write about your relationship and experience with music and your instrument.)
*
Video Recording or Zoom Meeting
Once we have received your application, we will follow up with two options for us to better understand you. 1). Submit a video recording of you playing a complete or excerpted repertoire. 2) A live Zoom meeting (more details will be sent before the meeting.)
Health and Wellness Information
The following questions should be answered by the applicant, or by a parent or guardian if the applicant is under 18. Please provide us with answers in the most clear and transparent way possible. Your responses will help MISMA to determine the applicant's readiness to adapt to the environment.
Does the applicant have a chronic health problem or disability about which the medical staff should know?
*
Yes
No
If yes, please explain the details of this condition, diagnosis, and treatment including medications, and any possible restrictions of activities.
Contact Us
oneheartinstitute@gmail.com
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