Music Ensemble Scholarship Application

Fields marked with an * are required

Student Information

Student Personal Email Address *

First Name *

Middle Name

Last Name *

Birthdate *

Permanent Address *

Country

Street

City

Region

Postal Code

Student Cell Phone *

Gender

Parent Information

Relationship *

First Name *

Last Name *

Phone *

Email Address *

Add another parent? *

Yes

Relationship *

First Name *

Last Name *

Phone *

Email Address *

Music Information

High School or Current Information

Music Teacher

Music Teacher Email

Select your Ensemble interest

Ensembles: Instrumental

Ensembles: Vocal

Indicate any awards you have received

Please indicate the instrument(s) you play.

Please indicate your voice part.

List any music activity you would like to participate in at Clarke (choir, band, jazz, woodwind/brass/string ensemble)

Academic Information

Major:

Are you interested in a minor?

Yes

Select your minor

Student Term*

Additional Information

How did you first learn about Clarke University?

Please indicate who referred you to Clarke University.

Please provide more detail.