Afro Latin Jazz Academy of Music and NYC Mission Society Prospective Student Application GRIOT (Global Rhythms in Our Tribe)
Minisink Townhouse, Fall 2018

FREE MUSIC PROGRAM for youth grades 3-12
**IMPORTANT DATES**

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Please drop off completed applications at the front desk of Minisink Townhouse: 646 Malcolm X Boulevard, New York NY, 10037. If you fill out this form, you will be called in for an in-person meeting to fill out a formal application.

Practice times:
Tuesdays and Thursdays, 4:30pm-6:30pm at Minisink Townhouse: 646 Malcolm X Boulevard, New York, NY, 10037.


For additional information please contact:

Lauren Fraulo
Education Coordinator
NYC Mission Society
lfraulo@nycmissionsociety.org
212.674.3500 ext.362


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Name: *
Grade: *
School: *
Phone Number: *
Email: *
How did you hear about us? *
Instrument of interest - Trumpet, trombone, drums/percussion *
(Rank choices 1-3; 1 being first, 3 being last choice)
Do you have any previous musical experience? If so, please describe. *
Why are you interested in learning to play an instrument? *
Why is music important to you? *
Do you have any parents and/or other family members who play an instrument? If so please list them and what instruments they play. *
Please list some of your all-time favorite musical artists! *
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