Southeast Missouri State University

Semester: (Required)

Fall
Spring
Summer

Student's Last Name: (Required)

Student's First Name: (Required)

Name of Student's School: (Required)

Student's Grade in School: (Required)

Student's Date of Birth: (Required)

Instructor Type - Choose One: (Required)

University Faculty (teachers employed by the Southeast Departement of Music. These faculty usually require an audition to be accepted into their studies.)

Professional Faculty (Teachers with college degrees and prior teaching experience.)

Student Faculty (Teachers who are music majors or minors in the Department of Music and have been recommended by a Departmental faculty member.)

Class Type - Choose One: (Required)

Instrument (list which type of instrument)

Voice

Adult Piano Class (15 weeks)

Musicianship Class only (no private lesson)

Suzuki

Session Weeks - Choose One: (Required)

Regular Session (15 weeks)

12 weeks

8 weeks

4 weeks

Session Length - Choose One: (Required)

Regular Session (30 minutes)

15 minutes

45 minutes

60 minutes

Estimated Course Fees:

Years Previous Lessons:

Preferred Teacher:

If you are a new student, how did you hear about the Music Academy?

Periodically we update pictures on the web site, using photos of our students at recitals, outreach program, the Barnes & Noble Bookfair, or posed shots. If you will allow the Music Academy to use photos of your student, please complete the following information.
(Required) I give permission to the Southeast Missouri Music Academy to use photographs of the student listed on this registration form, on the Academy web site - http://www.semomusicacademy.org/

Parent/Guardian Last Name: (Required)

Parent/Guardian First Name: (Required)

Home Phone: (Required)

Cell/Work Phone: (Required)

Email Address: (Required)

Street Address: (Required)

City: (Required)

State: (Required)

Zip Code: (Required)