2023/24 PCM College Prep Supplemental Application
DO NOT FORGET TO COMPLETE ENROLLMENT ON REGISTRATION WEBSITE OR PARENT PORTAL.

Welcome to PCM's College Prep Program (CPP). We are glad you are interested in joining our musical community and we look forward to making some great music with you.

Please pay attention to which fields are required and make sure to fill in any and all required information.

**ONCE WE RECEIVE YOUR APPLICATION, YOU WILL RECEIVE AN EMAIL TO SCHEDULE YOUR AUDITION AND COMPLETE YOUR MUSIC THEORY ASSESSMENT**

If you have any further questions please don't hesitate to reach our Program Managers: Meghan Ruel (mruel@pcmrocks.org) and Diego Miranda (dmiranda@pcmrocks.org)
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STUDENT INFORMATION
Student's Legal First Name: *
Student's Legal Last Name: *
Student's Nickname: *
(write N/A if not applicable)
Student's Preferred Pronoun: *
Student's Birthday: *
MM
/
DD
/
YYYY
Student's Race: *
SELECT ONE OR MORE
Required
Student's Cell Phone Number: *
(write N/A if not applicable)
Student's Email Address: *
Student's Grade Level for 2023/24 School Year: *
Student's School Name: *
(write Homeschool if student is homeschooled) 
Student's School District: *
(write Homeschool if student is homeschooled or N/A if not applicable) 
Student's Grade Point Average (GPA) or Average Letter Grade: *
Example: 3.8 or B+
Medical/Learning Accommodations:  *
Please list any medical conditions or learning difficulties the student has, as well as accommodations that your student requires. 
Student's Non-Musical Extracurricular Activities: *
Please describe any extracurricular activities the student is involved in and the days they occur.
PARENT/GUARDIAN INFORMATION
Primary Parent/Guardian's Name: *
Primary Parent/Guardian's Email Address: *
Parent/Guardian's Cell Phone Number: *
Secondary Parent/Guardian's Name: *
(write N/A if not applicable)
Secondary Parent/Guardian's Email Address: *
(write N/A if not applicable)
Secondary Parent/Guardian's Cell Phone Number: *
(write N/A if not applicable)
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