Thank you for your interest in the New York Jazz Academy® Jazz Intensives program. Please take a moment to fill out this application form so we can learn more about you and your musical pursuits. Someone will contact you shortly (typical response time is within 1-5 business days). If you have trouble submitting the form, or if you have additional questions, please email us. Thanks again for your interest in New York Jazz Academy®.

First Name (of student) *

Last Name (of student)*

Email Address*

Phone*

Alt. Phone (optional)

Mailing Address

Street Address

Address Line 2

City

State/Province/Region

Postal / Zip Code

Country

Birthdate (of student) example: 05/15/1980 for May 15, 1980

Parent/Guardian First Name (if student is under 18)

Parent/Guardian Last Name (if student is under 18)

Parent/Guardian Email Address (if student is under 18)

I am interested in programs for:
Adults (ages 18 + )Teens and Youth (Ages 5-19)

Instrument
---VoicePianoGuitarBassDrums/PercussionSaxophoneClarinetFluteOboeTrumpetTromboneTubaViolin/Viola/CelloOther

Instrument (if you selected "Other")

Skill level (approx.)
Total BegBegBeg-IntIntInt-AdvAdvPro

I am interested in (Check all that apply)
Summer Jazz IntensivesWinter Jazz IntensivesSpring Jazz IntensivesWeekend Jazz IntensivesCustom Jazz IntensivesOther programs

I am interested in*
Online and in-person optionsIn-person optionsOnline options

I am interested in attending the following number of weeks for Summer 2021 (Choose one)
1 week2 weeks3 weeks4 weeks5 weeks6 weeksMore than 6 weeks

I may have the flexibility to attend the following dates (Check any for which you are available)
July 5-9July 12-16July 19-23July 26-30August 2-6August 9-13August 16-20August 23-27Aug 30-Sept 3

Link to sound samples (Website, YouTube, etc.)

Comments (Please share with us a bit about your musical background and current goals)

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