Registration - Private Lessons

Please complete this form and mail your check (written to Susquehanna University) to Susquehanna University Music Preparatory Program, 514 University Avenue – Box RR, Selinsgrove, PA 17870 or pay online.

Student Name

Age

Parent/Guardian(s)

Home Phone Number

Work Phone Number

Best Time of Day to Call

E-mail Address

Street Address

City

State

Zip Code

Relationship to Child

School Presently Attending

Grade

School Music Teacher

Have you studied in the program before? *

	I am a new student in the Preparatory Program
	I have studied in the Preparatory Program

Years of Study With Program

Most Recent Teacher

Instrument

Years on Instrument

By completing this form, you agree to mail or pay online the $130 fee for 10 thirty-minute private lessons.

I understand that no more than 2 lessons will be rescheduled due to illness, inclement weather or other musical engagements.

Students accepted into the program are contacted by the assigned private teacher.

Registration - Private Lessons

Navigation

Registration FormsSub-Navigation:

Susquehanna University

Links

Be Social