New Student Application (JHMA)
Welcome to the Jazz Hands Musicians Academy (JHMA). Please fill out this intake form
Click Here if you are applying for the Jazz Hands For Autism Junior Academy
For other inquiries, email us at info@jazzhandsforautism.org
Please Note: Questions on this form are for the sole purpose of collecting background information on each student in order to develop an individualized music-based vocational training and job placement program to meet his/her unique needs. All given information is strictly confidential.
1. Fill out this form
2. Upload Intake Audition Video. Video must consist of you performing and showcasing your musical talents. It should be no longer than five (5) minutes. Upload your Intake Audition Video here.
3. Read carefully and sign the JHMA Ground Rules & Expectations (GRE) here
If you have not done so already, please schedule an intake interview using this LINK
|
BACKGROUND
Fill out with the information of applicant
ACCOMMODATIONS
| Any Special Arrangements, assistance student needs,etc. |
Explain way of communication, if Verbal or non verbal. Does this student possess any difficulties in communication? Indicate N/A if not applicable
Add notes/Explain if need be
(mobility arrangements, one-on-one staff, nonverbal, etc. If none, please enter N/A)
Do you need long breaks or short breaks? How long can you focus in class? How many back to back classes are you okay with taking? Do you need long breaks(1hr) or short breaks (5-15 min) if you are taking 4-6 back to back classes in one day? Explain.
Do you use the bus? Access? Get rides from mom/dad/ family? Do you travel on your own?
LEARNING ENVIRONMENT
We would like to hear about your current learning environment
Pick the one that best explains your learning environment at home
Tell us what type of internet connection you have
Diagnostic Assessment Preparation
Every incoming student of the Jazz Hands Musicians Academy (JHMA) is required to complete a diagnostic assessment on August or September to give us an idea of what you currently know in: music theory and 1-2 instrument(s) you want to learn at JHMA. The questions below will let us know how to help you prepare for the JHMA diagnostic assessment. The Diagnostic Assessment will be administered using a computer with a proctor in person at our studio. More details about the Diagnostic will be provided once you are admitted in the program.
Support means help clarifying questions, help logging on to the online system, etc
Personal Health Information
Everything in this section is confidential
Please include all diagnoses including behavioral, developmental and medical put N/A if not applicable
put N/A if not applicable
put N/A if not applicable
(indicate N/A if none available)
Select N/A if Not Applicable
Emergency Contact Information
Demographic Info
For JHFA data and report purposes. Choices based on 2020 U.S. Census. Check all that apply. Specify more details on.
What is race?
The Census Bureau defines race as a person’s self-identification with one or more social groups. An individual can report as White, Black or African American, Asian, American Indian and Alaska Native, Native Hawaiian and Other Pacific Islander, or some other race. Survey respondents may report multiple races.
What is ethnicity?
Ethnicity determines whether a person is of Hispanic origin or not. For this reason, ethnicity is broken out in two categories, Hispanic or Latino and Not Hispanic or Latino. Hispanics may report as any race.
|
EXPERIENCE
| Skills, volunteer experience, work experience |
What other talents or skills do you have aside from music? (acting, drawing, animation, etc)
What other interest do you have aside from music? (acting, drawing, animation, etc)
put N/A if not applicable
What musical skills do you want to learn? What musical preferences when learning?
What songs do you want to learn? What song genres are you open to learn? Write the name of the song and the original artist. If it is an original song, please indicate that
Describe any musical experience you had in the past. mention instruments if applicable (#years playing, how was trained with instrument, self taught/1on1 lessons). Mention any music production software you have experience in if applicable
Which music skill you'd like to learn or train with at JHMA?
Would you like to learn a secondary instrument other than the first one? If yes pick one that's different than the first one.
answer with the best of your ability. There is no right or wrong answer.
what do you want to learn, what are your goals by the end of this program, what do you need help on, etc.
What are your long term goals? What do you want to be in 3 years from now? 5 years? 10 years? If you don't know it, put I don't know
Write the name of the song and the original artist. If it is an original song, please indicate that
SOCIAL MEDIA
What are your social media links?
Weekly Availability to take Lessons
Fill out your weekly availability to help us get an idea how to build your class schedule.
Write down additional comments about your weekly availability
Anything else you'd like JHFA to know
SIGN
Please sign
For any additional questions, please email us at info@jazzhandsforautism.org with subject line: INTAKE/ADMISSION - Musicians Academy |
Upload Audition Video and Sign JHMA GRE
| For any additional questions, please email us at info@jazzhandsforautism.org with subject line: INTAKE/ADMISSION |