Jackson Tuesday Musicale
Student Music Award Application

The application appears below.  Click here to download a copy.  When completed, please return to:

Mrs. Mary Lou Lourim
JTM Music Awards Chair
2899 S. Wood Dale Dr.
Jackson, MI 49203
517-784-9810

JACKSON TUESDAY MUSICALE STUDENT MUSIC AWARD APPLICATION

Please return this completed form, postmarked by: March 14, 2013
Audition date: March 21, 2013

Name _____________________________________________________________________ Age _____ Grade _____

Address _______________________________________________________________ Phone __________________

Instrument/Voice ____________________________________________________________ Years experience _____

Name of teacher/instructor ____________________________________________ School ______________________

Repertoire to be performed:

_____________________________________________________________ Composer ________________________

_____________________________________________________________ Composer ________________________

Accompanist’s name _____________________________________________________________________________

Please sign below:

If I receive a Student Music Award from Jackson Tuesday Musicale, I agree to perform for Jackson Tuesday Musicale 
and to continue to participate in Jackson County musical activities.

______________________________________________  ________________________________________________

Applicant’s Signature                                                                        Parent/Gudardian Signature                                                                                                                                                                                          

Music Teacher’s Recommendation:

I recommend ___________________________________________ for a Student Music Award from Jackson Tuesday Musicale.

Music Teacher’s Signature ______________________________________________________