| Basic Information |
| Name: |
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| Instrument or voice type: |
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| E-mail address: |
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| Cell phone: |
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| Other phone, if any (please specify): |
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| Local Address |
| Local Address Line 1: |
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| Local Address Line 2: |
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| Local City: |
State: Zip:
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| Permanent Address |
| Permanent Address Line 1: |
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| Permanent Address Line 2: |
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| Permanent City: |
State: Zip:
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| Permanent phone: |
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| Student Status |
| Class: |
Undergraduate, Class of:
Graduate Student
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| School: |
Arts & Sciences
Engineering
Medicine
Public Health
Nursing
Other
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| Major: |
Check here if music minor
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| Audition Piece |
| Title: |
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| Composer/Arranger: |
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| Movement(s) and Duration of each: |
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| For singers only: Do you want an accompanist?: |
Yes
No
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| Other Information |
| Please attach music resumé: |
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| Additional information (optional) |
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