INSTRUCTIONS
Mr
Mrs
Ms
Miss
Dr
Other
Family Name:
Given Names:
Male
Preferred Name:
Female
Date of Birth
Day
Month
Year
Email:
Mailing address:
Number & Street or PO Box:
Suburb
State
Country
Postcode
Phone (
Mobile
Fax (
2. RESIDENCY STATUS
Are you an Australian citizen?
Yes
No
Yes
No
Yes
No
Yes
No
(If you have been granted a Permanent Humanitarian Visa in Australia, please attach a certified copy of your residency visa contained in you passport).
Have you been granted permanent residency (other than a humanitarian visa) in Australia?
Yes
No
(If you have been granted permanent residency (other than a Permanent Humanitarian Visa) in Australia, please attach a certified copy of your residency visa contained in you passport).
3. INSTRUMENT
4. EDUCATIONAL HISTORY
Name of School
Dates attended
Graduated
From
Yes
To
Award
No
High School:
Technical/Trade (after High School):
Tertiary Study:
Other education/training:
Phone
(07) 3216 1110
Email play@jazz.qld.edu.au
Web www.jazz.qld.edu.au
5. MUSIC EDUCATION
Current Instrumental or Vocal teacher(s)
Name
Location
Phone
Teacher
Grade
Result
Year
Examining Organisation
Have you studied the Board of Secondary School Studies Music Subject in Year 12?
Yes
No
Yes
No
Yes
No
If you have ticked YES, you will need to prepare documentation of any valid previous tertiary study or workplace experience to present to JMI on request.
Further information regarding Recognition of Prior Learning & Credit Transfer agreements are available under our policies on our website (www.jazz.qld.edu.au)
7. DECLARATION
Are you at present excluded, on academic or other grounds, from any tertiary institution?
Yes
No
I authroize Jazz Music Institute (JMI) to obtain information concerning my academic record from any school, university or other institution attended by me. I agree to inform JMI promptly
should I be excluded, suspended or expelled from any tertieary institution during the period of my enrolment at JMI. I consent to the collection, storage and disclosure of information
concerning any acts of record falsification or other irregular acts in relation to my academic record. I acknowledge that JMI may vary or reverse any decision made on the basis of
incorrect or incomplete information supplied by me. I authorize JMI to obtain information concerning my status required un the Higher Education Support Act 2003 (HESA). I
acknowledge that JMI may vary or reverse any decision made on the basis of such information once obtained.
Signature (applicant)
Date
JMI collects, stores and uses personal information only for the purposes of administering student and prospective student admissions, enrolment and education.
The information collected is confidential and will not be disclosed to third parties without your consent, except to meet government, legal or other regulatory authority requirements.
8. AUDITION DETAILS
A pre-audition interview with the Head of School is recommended. This interview is designed to assist applicants in preparing for audition.
Please phone JMI for an appointment for this interview.
Auditions are held every year from September through to late January. You may make an appointment at your conveniene for an audition during this period by
contacting JMI on the details provided at the bottom of the page
PAYMENT OPTIONS
Cheque (payable to Jazz Music Institute) (attached)
Cash (to be paid in person)
Visa
Mastercard
Name on card
Applications to be
forwarded with by post or
in person to:
Signature
Jazz Music Institute
or
PO Box 2215
Fortitude Valley BC 4006
47 Brookes Street
Bowen Hills Qld 4006
Expiry
T: 07 3216 1110
F: 07 3216 1150
www.jazz.qld.edu.au
play@jazz.qld.edu.au
Phone
(07) 3216 1110
Email play@jazz.qld.edu.au
Web www.jazz.qld.edu.au