Test DB

    part 1
    To be completed by the parent
    [get_title form-id="1478"]

    student first name

    [get_title key="first-name" value="First Name"]

    student last name

    [get_title key="last-name" value="Last Name"]

    date of birth

    [get_title key="date-of-birth" value="Date of Birth"]

    [get_title key="current-grade" value="Current Grade"]

    current grade (2015-16)

    [get_title key="grade-2015-16" value="Grade (2015-16)"]

    grade (2015-16)

    [get_title key="instrument" value="Instrument"]


    [get_title key="parent-guardian-first-name" value="parent(s) or guardian(s) first name(s)"]

    parent(s) or guardian(s) first name(s)

    [get_title key="parent-guardian-last-name" value="parent(s) or guardian(s) last name(s)"]

    parent(s) or guardian(s) last name(s)

    [get_title key="home-phone-number" value="Home Phone"]

    home phone number

    [get_title key="work-phone-number" value="Work Phone"]

    work phone number

    [get_title key="parent-cell-1" value="Parent Cell 1"]

    parent cell (1)

    [get_title key="parent-cell-2" value="Parent Cell 2"]

    parent cell (2)

    [get_title key="parent-email-1" value="Email 1"]

    parent email (1)

    [get_title key="parent-email-2" value="Email 2"]

    parent email (2)

    [get_title key="street-mailing-address" value="Street"]
    [get_title key="zip-code-mailing-address" value="ZIP"]
    [get_title key="city-mailing-address" value="City"]

    mailing address:



    zip code

    [get_title key="name-of-middle-school" value="Middle School"]

    name of middle school

    [get_title key="music-program" value="Music Program"]

    name of music program outside of school (if applicable)

    [get_title key="music-teachers-name" value="Music Teacher"]

    music teacher's name

    [get_title key="music-teachers-email" value="Music Teacher Email"]

    music teacher's email

    [get_title key="street-school-address" value="School Street"]
    [get_title key="street-school-address" value="School City"]
    [get_title key="zip-code-school-address" value="School ZIP"]

    school address



    zip code

    part 2
    Parents/Guardians: You must include a copy of the first two pages of your most recent tax form (2014 or 2015) indicating total annual household income. Applications submitted without income verification will not be considered.
    You can submit your tax form by postal mail, fax, or email.
    Mailing address:
    MSJA: Bronx
    Jazz at Lincoln Center
    3 Columbus Circle, 12th Floor
    New York, NY 10019

    Fax number: 212-258-9900
    ATTN: MSJA: Bronx

    msja@jalc.org with subject APPLICATION

    part 3
    To be completed by the student. Download and print this PDF. All answers must be neatly handwritten in the space provided, and brought with you to your first round audition.

    Download the part 3 PDF.

    part 4
    To be completed by music teacher, band director or guidance counselor.

    Answer the questions below on a separate piece of paper and mail, fax or email:

    1. Identify Student’s Name and School/Organization
    2. How many major scales can your student comfortably play?
    3. Describe your student’s ability to play by ear and read music.
    4. Why should your student be admitted to the Middle School Jazz Academy?

    Fax to: 212-258-9900
    ATTN: MSJA: Bronx
    Email: msja@jalc.org
    MSJA: Bronx
    Jazz at Lincoln Center
    3 Columbus Circle, 12th Floor
    New York, NY 10019

    part 5
    Mind Builders Creative Arts Center
    3415 Olinville Avenue, Bronx, NY 10467

    Please call 212.258.9789 to schedule your audition.

    part 6
    I, the parent or guardian, certify to the best of my ability that the information in this application is correct, and electronically sign my name below:

    I verify that I am 13 years of age or older