Academic Alliance Membership Form

Academic Alliance Membership Form

For Silver, Gold, and Platinum Membership
Please review the Qualification Criteria for each level of membership before beginning this application.

Please Note: This application is for individual elementary, middle, and high school band programs in the United States. School districts should complete an application for each school in the district. Please fill out our contact form if you have any questions.
School Name*
School Address*
City*
State*
Zip Code*
Based on the Qualification Criteria on this website, I anticipate that my band program will qualify for the following membership level:*

SilverGoldPlatinum
Primary Band Director*
First Name
Primary Band Director*
Last Name
Primary Email*
example@example.com
Primary Phone Number
Secondary Band Director
First Name
Secondary Band Director
Last Name
Secondary Email
example@example.com
Secondary Phone Number
Additional Band Staff

Preferred School Music Dealer(s)*
If you have already participated in an Academic Alliance Instrument Trial Program, let us know which program you have completed: (check all that apply)*

School Bid Wind InstrumentStandard Student Wind InstrumentConcert Percussion InstrumentsPerformance and Pro Level Wind InstrumentsMariachi InstrumentsOrff InstrumentsWe have not participated in an Instrument Trial Program
Please indicate which Academic Alliance Instrument Trial Program(s) your school is interested in conducting in the future. A KHS District Manager or your preferred dealer will contact you with details: (check all that apply)*

School Bid Wind InstrumentStandard Student Wind InstrumentConcert Percussion InstrumentsPerformance and Pro Level Wind InstrumentsMariachi InstrumentsOrff InstrumentWe are not interested in an Instrument Trial Program at this time
How did you first learn about the KHS America Academic Alliance?*

We are an existing Silver/Gold Level MemberJupiter Facebook/InstagramXO Facebook/InstagramJupiter WebsiteJupiter NewsletterNAfMESB&OSearch Engine ResultEducator ConventionDealer RepresentativeKHS RepresentativeOther EducatorOther
For Gold and Platinum Membership Only
Educator Testimonial statements are required for both Gold and Platinum Level Membership. Please provide a short statement telling us why you prefer Jupiter, Mapex, and/or Majestic Instruments or why you enjoy working with our company.*
For Gold Level Qualification, we would like for your existing instrument inventory of our brands to carry a value in excess of $60,000.00, as calculated by the Academic Alliance Instrument Value Form**. The assigned values are generous, so don’t be intimidated by this figure. What is the total value of your KHS instrument inventory, as calculated by this form?*
For Platinum Level Qualification, we would like for your existing instrument inventory of our brands to carry a value in excess of $120,000.00, as calculated by the form Academic Alliance Instrument Value Form**. The assigned values are generous, so don’t be intimidated by this figure. What is the total value of your KHS instrument inventory, as calculated by this form?*
**Download a blank Academic Alliance Instrument Value Form (Excel Format) to complete your Gold or Platinum membership application.
Upload your completed Academic Alliance Instrument Value Form (Excel Format)*

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To qualify for Platinum status within the Academic Alliance, we ask that Jupiter, Mapex, Majestic, XO, and Azumi make up at least 50% of your existing instrument inventory. Please name the KHS America Representative or Academic Alliance School Music Retail Dealer Representative who can verify this:*
In order to be considered for Platinum Level Membership it is expected that your school program is or has been visible in high-profile settings. Please indicate the activities below in which your program is involved: (check all that apply)*

Hosting All-Region or SimilarState Convention PerformanceHosting Contest/FestivalsNational Convention PerformanceHosting Community BandState Marching Band ParticipationBOA Regionals/Grand NationalsOther
We ask that Gold and Platinum Level Members of the KHS America Academic Alliance display our brand logos, when permissible and appropriate. Please see the Qualification Criteria for further examples and definition.

If your school is accepted as a Gold Level KHS Academic Alliance School, we ask that you strive to purchase at least 50% Jupiter, Mapex, Majestic, XO, or Azumi instruments moving forward and that these brands are also included on any formal bid lists in order to receive the Platinum Level Benefits.

If your school is accepted as a Platinum Level KHS Academic Alliance School, we ask that you strive to purchase at least 80% Jupiter, Mapex, Majestic, XO, or Azumi instruments moving forward and that these brands are also included on any formal bid lists in order to receive the Platinum Level Benefits.

It is also expected that educators from Platinum Level Member Schools will participate in our social media channels (Facebook, Twitter, and/or Instagram) and the AcademicAlliance.com website, and encourage student participation as well (when appropriate).
For All Membership Submissions
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Should be Empty:

	Year (ex. 2014)
Jupiter
Mapex
Majestic
XO Brass
H Jimenez
Sonor Orff

Academic Alliance Membership Form

For Gold and Platinum Membership Only

For All Membership Submissions