Student Information Form

Student Information Form
Name*

First NameLast Name
Email*
Please use a personal (non-school) email. example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Primary Instrument*
High School or Current College/University*
I am interested in:*

Music MajorMusic MinorEnsembles Only

Undergraduate Music Major Options
I am interested in:*

Applied Music: CompositionApplied Music: Jazz StudiesApplied Music: PerformanceMusic BusinessMusic EducationMusic Therapy

Undergraduate Music Minor Options
I am interested in:*

Music MinorMusic Minor: Jazz StudiesMusic Minor: Music Business

Non-Major Performance Options
I am interested in:*

Private lessonsBandsChoirsOrchestrasJazz

I am a:*

Current high school studentCurrent WIU studentCurrent college student (non-WIU)
Graduation Year (High School)*
Graduation Year (College)*
Questions/Comments
Should be Empty: