2021 Musician Intake Form Please enable JavaScript in your browser to complete this form.GENERAL INFORMATIONName *FirstLastPersonal Email *Phone Number *Mailing Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeThis is where your stipend checks will be mailedMain Instrument *Auxiliary Instrument (Optional)FOR AYS WEBSITEBasic info for your AYS musician bio page. Please only include things you wish to be shared publicly. Short biography, please provide information about your studies, notable achievements, or past playing history. 250 words or lessImage Upload (Please upload a headshot/portrait for AYS use on social media accounts, website, and publication) * Click or drag a file to this area to upload. JPG or PNG, 1 mb maxWhy were you interested in joining American Youth Symphony? *Would you participate in smaller AYS ensembles concerts? *YesNoWhere do you see yourself in 5 years? *Social Media Accounts (Optional)Personal Website (Optional)EDUCATIONPrivate Teacher Name *FirstLastPrivate Teacher Email *Current Student? *YesNoSchool: *Degree Program: *(Ex: High School Diploma; Performance Diploma (PD); Bachelor of Music (BM); Master of Music (MM); Artist Diploma (AD); Doctor of Musical Arts (DMA); etc.)Most Recent School: *Highest Degree Completed: *(Ex: High School Diploma; Performance Diploma (PD); Bachelor of Music (BM); Master of Music (MM); Artist Diploma (AD); Doctor of Musical Arts (DMA); etc.)EMERGENCY CONTACTEmergency Contact Relationship: *Emergency Contact Name *FirstLastEmergency Contact Phone *Emergency Contact Email *Emergency Contact AddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDEMOGRAPHICS We’re asked to report certain demographic data to funders and data scientists reporting on the arts. Responses will be kept anonymous. Gender *FemaleMaleNon-binaryPrefer not to answerRace and Ethnicity: Please select any/all that apply *American Indian or Alaska NativeAsianAfrican AmericanNative Hawaiian or Other Pacific IslanderHispanic or LatinoWhiteAUTHORIZATIONSI have a United States Social Security # *YesNoYou must be able to legally work in the U.S. AYS bears no responsibility in obtaining work permits for applicants who are not naturalized US citizens. You must be able to provide documentation of your ability to work. F1 visa holders cannot accept off-campus employment at anytime during the first year of their studies. Under certain circumstances, the U.S. Citizenship & Immigration Services (USCIS) may grant permission to accept off-campus employment after one year of study. F-1 students may accept on campus employment in your university without seeking prior permission from USCIS. Media Release: I grant permission to the American Youth Symphony (AYS) and its agents and employees the irrevocable and unrestricted right to reproduce photographs, audio and/or video images taken of me for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release AYS and its legal representatives for all claims and liability relating to said images, audio or video. I waive my right to any compensation. *I understand and accept the statement above.I am under age 18, and require a parent or guardian signature.SECURE FILE UPLOAD: Please upload your W9 form. This is required for processing your stipend payments. * Click or drag a file to this area to upload. QUESTIONS OR COMMENTS?If you have any questions or comments about the information collected in this form, please include them here:NameSubmit
