Beyond Music

Date *

MM

DD

YYYY

Name *

First Name

Last Name

Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birth Date *

MM

DD

YYYY

Marital Status *

Single

Married

Are you currently enrolled in school? *

Yes

No

What is the highest level of school you have completed? *

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

GED/HiSET

Have you completed any higher education? *

None

Trade School/Cert. Program (No Completion)

Trade School/Cert. Program (Completed)

Some College (No Degree)

Associate's Degree

Bachelor's Degree

What is your employment status? *

Employed Full-time

Employed Part-time

Unemployed

Have you ever recorded in a studio? *

Yes

No

Have you ever used protools?

Yes

No

Are you interested in engineering? *

Yes

No

Do you have any felonies on your record? *

Yes

No

Are you on probation or parole

Yes

No

Have you been diagnosed with any mental health conditions?

Yes

No

If yes, are you currently taking medication(s) or receiving treatment?

Yes

No

Do you have any disabilities?

Yes

No

Are you currently drug-free?

Yes

No

Are you involved in any structured activities? (I.e. sports team, church, music group, etc.)

Yes

No

How did you hear about this program?

Flyer

Parole Officer

Website

Community Partner

Previous/Current Student of any of M:STL's programs

Other