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 *
Your answer
Student Last Name *
Your answer
Email *
If no email, please enter "N/A" and include phone below.
Your answer
Mailing Address 1
Your answer
Mailing Address 2
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Home Phone
Your answer
Mobile Phone
Your answer
Musical Background:
What type of instruction do you seek?
If instrumental, please enter the instrument.
Your answer
Do you own the instrument you want to study at ECMI?
Have you previously studied music?
Do you read music?
Please select your preference for instruction.
Where did you hear about ECMI?
Your answer
Comments or Questions
Please let us know if you are currently a student of an ECMI faculty member.
Your answer
For Students 18 or under:
Student Date of Birth
MM
/
DD
/
YYYY
Name of School
Your answer
Grade
Your answer
Parent or Guardian First Name
Your answer
Parent or Guardian Last Name
Your answer
Parent Email
If same as student, enter "same"
Your answer
Parent Home Phone
If same as student, enter "same"
Your answer
Parent Mobile Phone
If same as student, enter "same"
Your answer
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