Enrollment Application

Information provided will be used to determine and verify eligibility for program services and to ascertain the appropriateness of selected services.

Student information
Student's Full Name
Parent/Guardian's Name1
Parent/Guardian's Name 2
Age: Grade: School:
Home Address


Phone1 (xxx)xxx-xxxx
Phone2 (xxx)xxx-xxxx

Are you a returning student?

Instrument of desired study:

  Guitar     Piano     Percussion    Voice    

Additional classes:

Music Mentor applicants must comply to the program requirements prior to receiving instruction.
Program Requirements. By clicking this checkbox I am agreeing to comply with the program's requirements. The program's requirements are:

1) A copy of the child's last report card
2) An instrument on which to practice
3) Parental attendance at the Orientation Meeting
4) Signed consent form, which includes an agreement to the attendance policy

For SPAM protection, you must type in the number 16 and submit your request: