New Student Application and Agreement Form

This application is for those who are interested in becoming students at the Le Nota School of Music. In order for your lesson plan to be ready to start from the very first lesson, and to reserve your lesson time with a teacher you must e-mail the answers at least seven days in advance of the first lesson to: namu@lenota.com Le Nota School of Music.

STUDENT INFORMATION

Student Name:
Date of Birth:	Home Phone: Work Phone:
E-mail:	Mailing Address:
Parent/Guardian (in case of emergency contact):

Previous Music Experience? ( Y / N )

Instrument/# of Years Studied:
_______________________________________________________

Previous method books, technique books used:
_______________________________________________________

Participated in Certificate of Merit? ( Y / N )
If yes, specify last grade level passed:
______________________________________________________

Please list any participation in workshops, recitals, festivals, competitions or other musical activities:
_______________________________________________________

Musical Interests

Indicate which instrument(s) you wish to study:
_______________________________________________________

The following is just a small list of reasons why people choose Le Nota School of Music for lessons. Please circle any which apply to you and feel free to clarify or add to the list. This information helps in determining appropriate methods and musical literature for the individual student.

· EXPERIENCED: Want to work on advanced musicianship

· EXPERIENCED, BUT with gaps in knowledge (remedial technique, music theory, musicianship, etc.)

· COMPOSITION

· CLASSICAL

· JAZZ and IMPROVISATION

· POPULAR STYLES

· CERTIFICATE OF MERIT

· COMPETITIONS

· ADULT STUDENT studying for fun or personal growth

OTHER:

For Primary through High School Students

Grade Level:
_______________________________________________________

Enrolled in Special Academic Programs
("Magnet", G.A.T.E, M.G.M., etc.)? (Y / N)

Which Program?
_______________________________________________________

Who referred you to Le Nota School of Music?

Current Student / Parent of Student:

Internet Search Engine:

Google
Yahoo!
Microsoft Network (MSN)
Other:____________________________________

Church Choirs:

American Samoa
Australia, New Zealand, Hawaii, California
Other: ____________________________________

· Other Referral:
__________________________________________

I understand the School Policy and I accept its terms.

PARENT or GUARDIAN (if applicable):

_______________________________________________________

SIGNATURE:

________________________________________DATE:__________

STUDENT:

_______________________________________________________

SIGNATURE:

________________________________________DATE:__________

Le Nota School of Music | 1054 Aua Rd, Pago Pago | American Samoa 96799