RHSM STUDENT APPLICATION
Please complete this student application as accurately as you can.

Note:  Student application fee is $90 per student.
           Maximum of $180 per family.

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FULL NAME: *
Please enter the full name of the prospective student
Address: *
Please enter your street address here
City: *
Please enter your city name here
State: *
Please enter your state
Zip Code *
Please enter your zip code
Date of Birth: *
Please enter the students date of birth mm/dd/yy
Name of Current School: *
Please enter the name of the school your student is currently attending.
Grade: *
Please enter the students current grade level.
Parents' Name: *
Please enter the first and last name for the primary parent contact.
Parent Occupation:
Please enter your occupation.
Home Phone: *
Please enter your home phone number (area)-(number)
Work Phone:
Please enter your work phone number.
Mobile Phone:
Please enter your cell phone number.
Email Address: *
Please enter the primary contact email address.
Months/Years of Piano Study: *
Please the number of months and/or years of piano study.
Have you done any written music - Theory?
What types of Music are you interested in learning? *
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