Special Music School Application, Grades 1 and 2
Thank you for your interest in Special Music School!

If you have not already done so, please visit our website, www.kaufmanmusiccenter.org/sms, for more detailed information regarding the assessment process, information sessions, and student life, as well as a series of frequently asked questions. Please note, the form will not save in-between sessions, so it will need to be completed all at once.

Applicants for the 1st and 2nd grade classes of 2019-2020 will be assigned an assessment time as soon as there are enough applicants to fill an assessment session.

The application is due January 15, 2019. All assessments for 1st and 2nd grade will tentatively be held in late February and March 2019.

Basic Information
Student Last Name *
Your answer
Student First Name *
Your answer
Student Middle Name
Your answer
Student Nick Name
Your answer
Birthdate *
MM
/
DD
/
YYYY
Student Gender *
Applying for Grade: *
Student Ethnicity
Select all boxes that apply. You may select more than one group.
Parent/Guardian 1 Name *
Your answer
Relationship to Applicant *
Your answer
Parent/Guardian 1 Phone Number *
Please do not include dashes, periods, or any punctuation with your phone number.
Your answer
Parent/Guardian 1 E-Mail *
E-Mail is the primary means of communicating with Special Music School. Please ensure you list an email that you check frequently.
Your answer
Parent/Guardian 1 Occupation
Your answer
Parent/Guardian 2 Name
Your answer
Relationship to Applicant
Your answer
Parent/Guardian 2 Phone Number
Please do not include dashes, periods, or any punctuation with your phone number.
Your answer
Parent/Guardian 2 E-Mail Address
Your answer
Parent/Guardian 2 Occupation
Your answer
Student Street Address *
Include apartment number, if applicable.
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Fax Number
Your answer
Current School Name *
If Home-Schooled, please write "Home School"
Your answer
Current Grade Level *
Your answer
Classroom Teacher *
Your answer
Classroom Teacher E-Mail
Your answer
Parent Questionnaire
How did you hear about us?
Please feel free to elaborate on your previous response.
For example, a specific website, person, publication, or event.
Your answer
What makes you think your child might be musical? *
Your answer
What kinds of musical activities does your child participate in at home? *
Your answer
What musical events has your child attended? *
Your answer
Has your child had formal music lessons or classes? If so, what kind? Does s/he play a musical instrument? If so, how long has s/he studied? *
Your answer
If you responded "yes" to the previous question, what was your child's response to music lessons?
Your answer
List the name(s) of your child's private lesson teacher(s):
Your answer
Are there any musical instrument in your home or at your child's school? If yes, has your child shown any interest in it/them? In what instrument(s) is your child particularly interested? *
Your answer
Have any members of your family had music training, either instrumental or vocal? *
Your answer
Is there anything else that you would like to tell us about your child?
Your answer
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