Application Form

Applicant's Full Name (Apply by March 8 for an 8% discount)

First NameLast Name
Parent's Full Name
Contact Number
Please enter a valid phone number.
Payer's Email Address
example@example.com
Applicant's email address*
example@exdample.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant's Age
I identify as (gender)

------female------male------non-binary------other
food restrictions:
We will try to accommodate any and all.
specify your instrument

------piano------violin------viola------cello------classical guitar------mandolin------composer------singer/songwriter with guitar background------singer/songwriter with piano background------voice
for singers: voice type -- soprano, mezzo, alto, tenor, bass
Do you wish to study a second instrument or composition? If so, specify:
Must be an instrument offered -- piano, guitar, strings
teacher's name
Describe your goals. What kind of program should we tailor for you?
Would you like to schedule an interview? Yes or No. If yes we will arrange by email.
Please include $60 non-refundable application fee. Fee will be applied to tuition upon acceptance if application is received before March 1st. .

Payment options

1 -- preferred

Pay by Zelle using this email address: francesummermusicyxie@gmail.com

2
Send check payable to
Roger Shapiro Fund
to

112 Central Parkway
Mount Vernon, NY 10552

3
request wiring instructions by email -- francesummermusicyxie@gmail.com

After April 1st payments must be made online.
Should be Empty: