Audition and Scholarship Application

First Name:
Middle Initial:
Last Name:
Your instrument:
 
Present Address:
Street Address Line 1:
Line 2:
City:
State:
Zip Code:
Country:
Land Phone at this address: (111-111-1111)
Permanent Address:

Street Address Line 1:
Line 2:
City:
State:
Zip Code:
Country:
Land Phone at this address: (111-111-1111)
Cell Phone: (111-111-1111)
Email:
Birth date: (yyyy)
Are you an Ohio resident? Yes No
Sex:
 Male Female
 
 

Are you a U.S. Citizen? Yes No
 
If No, please complete this section and provide documentation that supports your immigration status.
  visa type:
  Refugee/Asylee/Other:
 
  If permanent resident, card No.:
  Date granted: (yyyy)
 
  Country of citizenship:
  Country of birth:


The information on racial/ethnic status and sex is requested to meet federal reporting requirements. It will not be used to adversely affect any admission decision.
 
  Ethnicity:

Parents or next of kin:
Name(s):
Street Address Line 1:
Line 2:
City:
State:
Zip Code:
Country:
Land Phone at this address: (111-111-1111)
Parent’s email 1
Parent’s email 2

Please provide the following regarding your education:
  Name Location Major/Degree Current Year Graduation Date
(or anticipated)
Current Institution (yyyy)
Previous Institution   (yyyy)
High School   (yyyy)

 

Have you ever attended Kent/Blossom Music? Yes No
  If Yes, when (yyyy)

Present Position (Please be specific, college student, orchestra musician, teacher, etc.):
Employer:
Employer Address:
 
Please check any auxiliary instrument(s) you play:
Harpsichord Piccolo English Horn Eb Clarinet Bass Clarinet Contrabassoon

 

List major applied teachers and dates of study.
Teacher First Name Teacher Last Name Institution Dates Email
1
2
3
4

Please indicate how you learned of Kent/Blossom Music:
Former Kent/Blossom Students Advertisement (publication)
Bulletin board posting Internet
Teacher Other