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)

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 Beg Beg Beg-Int Int Int-Adv Adv Pro

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

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

I am interested in (Check all that apply)
 Summer Jazz Intensives Winter Jazz Intensives Spring Jazz Intensives Weekend Jazz Intensives Custom Jazz Intensives Other programs