2018 Graduate Music Workshops Graduate Music Workshop Registration Form Please print this form, fill out all information, and mail it with your payment to the address given below.

Name: ID Number:

Last, First, Middle/Maiden Required for Ithaca College Students

Birth date: SSN: ________ - ______ - _________

Address:

Street, City, State, Zip

Phone: E-mail:

Have you registered at Ithaca College before? Yes No

Are you a current matriculated Ithaca College student? Yes No

College(s) attended (institution and highest degree):

Are you a citizen of the United States? Yes No If no, country of citizenship:

Type of visa (if applicable): Visa Expiration Date:

WORKSHOP ENROLLMENT 2 Graduate Credits Noncredit $ 1514 $ 757

Wind Conducting Symposium O O

Choral Conducting Workshop O O

Music and Movement O O

The federal government requires (under Title VI of the Civil Rights Act of 1964 and Title XI of the Education Amendments of 1972) that institutions of higher education collect information on the ethnic composition of their student population. The information you provide below will be used to meet these federal requirements. All information given on this form will remain confidential.

Are you Hispanic or Latino?

Hispanic or Latino�

Not Hispanic or Latino�

OVER

Regardless of your answers to the prior questions, please select one or more of the groups below that describe you:

American Indian or Alaska Native (including all Original Peoples of the Americas)�

Asian (including Indian subcontinent and Philippines) �

Black or African American (including Africa and Caribbean) �

Hispanic/Latino (including Mexico, Cuba, PR, Central and South America, and Spain) �

Native Hawaiian or Other Pacific Islander (Original Peoples) �

White (including Middle Eastern)�

PAYMENT Matriculated Ithaca College students will be charged through their Homer accounts for the amount indicated above—send no payment with your completed Graduate Music Workshop Registration Form. All others, please mail completed Graduate Music Workshop Registration Form with check made by payable to Ithaca College, to the following address:

Ithaca College, School of Musicc/o Les BlackWhalen Center, Room 3322953 Danby Road Ithaca, NY 14850

Workshop registration dates: February 12 - June 15, 2018