Studio 4 LA Membership Application

Studio 4 LA Membership Application

To apply to Studio 4 LA, please complete all questions below. The application will take approximately 15-30 minutes to complete. You can save your responses and complete later if you are not able to complete the entire application in one sitting.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Preferred Method of Communication
Which of the following are you interested in (check all that apply):*

Earning your high school diploma through YouthBuild Charter School of CaliforniaSong writingProduction / beat makingAudio engineeringPodcastingBusiness of Music (artist management, A&R, brand management, creative direction, etc)Other
How did you hear about Studio 4 LA?
If you chose other, please explain*

Educational Background/Information
Name, City and State of Last School Attended*
What dates did you attend this school? (Give your best guess if you aren't sure)*
Highest grade level you completed*
Have you ever received Special Education services?*

YesNoUnsure
Have you ever had an IEP or 504 Plan?*

YesNoUnsure
Why did you drop out/leave your previous high school?*
Are you currently enrolled in a GED program or other school?*

YesNo
If yes, please describe

Personal Statement
Briefly explain why you want to participate in our program.*
What would you consider to be your strengths?*
What goal (for your life, future, family, etc.) will you use to stay motivated, and give your best effort while enrolled at Studio 4 LA?*
How will you get to Studio 4 LA every day? *
Please describe any previous experience you have with music and the recording arts. This could include both in previous school(s) and/or in your personal life.*
Our program includes a variety of learning activities. Do you agrees to participate in all activities inside and outside the classroom?*

YesNo
If no, why not?

Emergency Contact Information

Please list two individuals we can reach in case of an emergency, and be sure to let them know you have listed them. Include cell and home phone numbers.
Emergency Contact 1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship *
Emergency Contact 2*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Certification and Signature
I hereby certify that the information in this application is true and correct to the best of my knowledge. I also authorize Studio 4 LA staff to verify this information when reviewing my eligibility for the program. I understand that I may be asked to provide documentation and agree to sign, if asked, one or more release forms to allow Studio 4 LA to verify the information provided in this application.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Background and Personal Information