Applicant’s Full Name*

Applicant’s Birthday*

Applicant’s Parent's Full Name (if the applicant is under the age of 18)

Email*

Phone Number*

Choose Category*
Junior: RCM levels 2-4 (or equivalent experience)Intermediate: RCM levels 5-7 (or equivalent experience)Advanced: RCM levels 8-ARCT (or equivalent experience)

Performing Piece’s Title, Composer, & Duration* (separated by comma)

School You Attend*
Music Gallery & AcademyTri-City School of Music

Name of Your Teacher*

Portrait Photo of Applicant (optional)
The file size must be less than 3MB.

Message (optional)