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Student Registration Form
Delta State University The Art of the Piano 2022
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* Indicates required question
Email
*
Your email
Student Name:
*
Your answer
Parent's Name:
*
Your answer
Parent's E-Mail Address:
*
Your answer
Phone Number:
*
Your answer
Piano Teacher Name / E-Mail Address:
*
Your answer
School:
*
Your answer
Grade (as of March 2022):
*
5K
1
2
3
4
5
6
7
8
9
10
11
12
College or university student (undergraduate)
Graduate student
Other:
Years of Piano Study (as of March 1, 2022):
*
Your answer
Do you wish to have your recorded performance featured in a virtual recital?
*
Yes
No
Would you like to work with one of our DSU piano faculty members in an online master class, if selected?
Yes
No
Clear selection
If you said yes to the above question about an online master class, please choose which session(s) will work for you. Check all that apply:
1:00-3:00 p.m. on March 4, 2022 (CST)
5:00-7:00 p.m. on March 4, 2022 (CST)
If you are a 12th grader or a community college student, are you auditioning for DSU admission and music scholarships?
Yes
No
Maybe
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