APPLICATION FORM

Please type or print name and double-check correctness.
These forms are used as a basis for Certificate printing.
Student Name ________________________________
Phone ______________________________________
Address_____________________________________
City ____________________________ Zip ________
Email address ________________________________
Instrument ___________________________________
Level [circle level(s) from which student is graduating]:
Twinkle 1 2 3 4 5 6 7 8 9 10 (Twinkle graduation not available for Bk 1 & up graduates.)
I certify that this tape recording was made from memory,
and reflects my best effort.
Student signature _______________________________
Parent signature ________________________________
I recommend this student for participation in the Book
Promotion Concert.
Teacher signature _______________________________
Phone __________________ Email ________________

Fee is $10.00, and includes a trophy and certificate. If student is graduating from more than one level, contact Lani Hill for fee amount.

Note: Children receiving a Book 1 award are not eligible for a Twinkler award. These are only for students not ready to receive a Book 1 award.

Total fee enclosed: ______________________________
Make check payable to VSSA.
Send package containing recording, application and check to Lani Hill, 17649 S. 140th St., Gilbert AZ 85296.
Packages should be postmarked by March 1st, or hand-delivered at group lessons.
No late tapes or applications will be accepted.