Name          Date 
 

  Home Street Address        Phone 
 

  City, State, Zip Code   
 

  College/Institution You Plan to Attend  Accepted?   Deposit paid? 
 

  Grade Point Average and/or Rank in Class 
 

  Father's Occupation    Mother's Occupation 
 

  Brothers & Sisters (Number and Ages) 
 

  Participation in District, All-State, All-Eastern Concerts:  Please fill in the year, place an "X" in the

  appropriate festival column; then complete the group and instrument/vocal columns. 
 

Junior        Senior All-   All-  Band, Chorus Instrument/ 

           Year District       District State   Eastern Jazz, Orch Voice Part 
 
 
 
 
 
 
 
 
 
 
 
 
 

          The information set forth above is true and complete, to the best of my knowledge.

Parent's Signature_____________________________ Student's Signature___________________________

  Name of your High School      School Phone 
 

  High School Street Address 

  City, State, Zip Code 

  Music Department Sponsor:

  Name (Print)       Signature 
 

  Guidance Department/Counselor:

  Name: (Print)       Signature 
 

  School Principal/Headmaster:

  Name: (Print)       Signature