Monroe Street Fine Arts Center

Student Name:

Student Age:

New or Returning Student?
 New Student Returning Student

Area of Interest

private music-pianoprivate music-violinprivate music-celloprivate music-double bassprivate music-electric bassprivate music-guitarprivate music-fluteprivate music-harmonicaprivate music-voiceprivate music-trumpetprivate artgroup musicgroup art

Parent name: (if applicant is a minor)

Street Address:

City:

Home Phone:

Email:

Pre-tax household income, parent/guardian #1:

Pre-tax household income, parent/guardian #2:

Other sources of income:

Please list special circumstances your family is experiencing and/or specific requests that may aid in our decision making.

How much can your family contribute towards lessons?

Brief statement of interest from student:

How did you hear about Monroe Street Fine Arts Center?