New Season: Musician Intake Form Please enable JavaScript in your browser to complete this form.GENERAL INFORMATIONName *FirstLastEmail *Phone *Local 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 mailedInstrument *Auxiliary Instrument (Optional)FOR AYS WEBSITEBasic info for your AYS musician bio page. Please only include things you wish to be shared publicly. IMAGE UPLOAD: Please upload a headshot/portrait for us to include on the AYS website. * Click or drag a file to this area to upload. JPG or PNG, 1 mb maxWhat was your first season with AYS: *2019/20 (this will be my first season)2018/192017/182016/172015/162014/152013/142012/132011/122010/11Current Age: *Name of your hometown: *Favorite piece of classical music:Favorite piece of NON classical music: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 is my: *ParentOther family memberFriendGirlfriend/Boyfriend/Partner/SpouseOtherEmergency Contact Name *FirstLastEmergency Contact Phone *Emergency Contact Email *Emergency Contact Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact Profession or Occupation:DEMOGRAPHICS 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 *AsianBlack/African AmericanHispanic/LatinxMiddle Eastern/North AfricanNative AmericanPacific IslanderWhiteOtherPrefer not to answerIf you selected "other," please share any other racial or ethnic identity you would like to include:Groups - Some funders ask about the participation of certain groups in our programs. If you feel comfortable, please check the boxes for any groups that describe you: *I am a veteran.I am part of the LGBTQ community.I am on the autism spectrum.I have a physical disability.I have a mental or learning disability.I am a current or former foster youth.I came to the United States from another country.Non applyOtherIf you selected "other," please share any other group you would like to include:Income - Please describe your family household income while you were growing up: *Less than $45,000$45,000 - $139,000$140,000 - $149,999$150,000 - $199,999$200,000+Prefer not to answerDo not knowAUTHORIZATIONSWork Authorization *I have a United States Social Security NumberI have a Visa that allows me to work in the USCountry of Citizenship and Visa TypeMedia 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.QUESTIONS OR COMMENTS?If you have any questions or comments about the information collected in this form, please include them here:WebsiteSubmit
