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Wintergreen
Music Academy
Application Form

Current as of April 14, 2001
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Music Academy Application Form!

This form can be completed and sent on-line with the $20.00 application fee and audition tapes mailed separately (see Academy page). Alternatively this form may be printed and mailed.

Simply complete the form and click "Submit to WPA". In some cases you may need to print the form and mail it with signatures. Just click here and print the page.


Thank You !

Your Name:

Instrument(s):
Age:      Date of Birth      Sex
Social Security Number:

Parent/legal guardian's name:
Parent/legal guardian's signature: If under age 18, an application must be PRINTED and sent via U.S. Mail and must contain signature of parent / legal guardian.
Permanent Address:
City:
State:
Zip:
Phone:
( )
Fax:
( )
E-Mail:
Temporary (school) Address (through June 15, 2001):
City:
State:
Zip:
Phone: ( )
Work Phone: ( )
Moble Phone: ( )
School E-Mail:
School You Now Attend:


Grade YR

Present Teachers Name:
Teachers Phone:
( )
Present Teachers Address:
City:
State:
Zip:
Name of Wintergreen Faculty Mentor (if known):

(It is not necessary to have a Faculty Mentor to apply.)
Current and Previous Musical Training:
Chamber Music Experience:
Orchestral Experience:
Content of Application Tape:
Academy Housing Information
Your Name:
Instrument(s):
Address (June 1 thru June 27th):
City:
State:
Zip:
Home Phone:
( )
Work Phone:
( )
Fax:
( )
Home Town Newspaper:
Newspaper Phone:
( )
Newspaper Address:
City:
State:
Zip:
Date of Arrival:
,
Arrive By:
Car Airplane
Date of Departure from Wintergreen:
,
Will You Have An Automobile:
Yes No
T-Shirt Size :
S M L XL
Emergency Medical Insurance Company Name:
Emergency Medical Insurance Company Name:
Emergency Medical Insurance Policy Number:
Person to contact in case of emergency:
Relationship to applicant:
Person emergency home phone:
( )
Person emergency work Phone:
( )
Person emergency mobile (cell) Phone:
( )
Parent/legal guardian's signature: If under age 18, an application must be PRINTED and sent via U.S. Mail and must contain signature of parent / legal guardian.

Click "Submit" to send your application:

 

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Copyright 2001
Wintergreen Performing Arts All rights reserved