Student Information Form Please complete all fields below. Returning students, please complete this form as well. First Name: Last Name: Student Date of Birth: Gender: MaleFemale Street Address Line 1: Street Address Line 2: City: State: Zip Code: County: Home Phone: Student Cell Phone: Student Email: Student Instrument: School you attend: Grade Attending (2016-17): 2nd3rd4th5th6th7th8th9th10th11th12th Residence Area (for grant purposes): RuralUrban Age Bracket (for grant purposes): 6-1213-19 Race (for grant purposes): AsianBlackHispanicWhiteOther Private Teacher's Name: Is the student in his/her School Band/Orchestra/Choir? YesNo If yes, Director's Name: Father's First Name: Father's Last Name: Father at same address as student? YesNo Father's Employer: Father's Occupation: Father's Work Number: Father Cell Number: Mother's First Name: Mother's Last Name: Mother at same address as student? YesNo Mother's Employer: Mother's Occupation: Mother's Work Number: Mother Cell Number: Preferred Email address for Billing and Important Information: I understand that all instrumentalists MUST bring to the audition a $25.00 non-refundable audition fee in the form of a check made out to the Ethos Youth Ensembles. If accepted into an Ethos Ensemble, I understand that that money will be credited toward my tuition. I also understand that ALL STUDENTS must pay $25 before the first rehearsal. I also affirm that we have read the Parent/Student Handbook and are familiar with the Ethos rehearsal/performance calendar and policies and procedures.