Ellsworth Community Music Institute 2019-2020 Lesson Inquiry Form
Thank you for your interest in lessons at Ellsworth Community Music Institute (ECMI) !
We ask that you complete this inquiry form to begin our communications.
Once received, our Artistic Director will be in touch. We look forward to speaking with you!
Contact Information:
Student First Name *
Student Last Name *
Email *
If no email, please enter "N/A" and include phone below.
Mailing Address 1
Mailing Address 2
City
State
Zip
Home Phone
Mobile Phone
Musical Background:
What type of instruction do you seek?
If instrumental, please enter the instrument.
Do you own the instrument you want to study at ECMI?
Clear selection
Have you previously studied music?
Clear selection
Do you read music?
Clear selection
Please select your preference for instruction.
Where did you hear about ECMI?
Comments or Questions
Please let us know if you are currently a student of an ECMI faculty member.
For Students 18 or under:
Student Date of Birth
MM
/
DD
/
YYYY
Name of School
Grade
Parent or Guardian First Name
Parent or Guardian Last Name
Parent Email
If same as student, enter "same"
Parent Home Phone
If same as student, enter "same"
Parent Mobile Phone
If same as student, enter "same"
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy