Academic Music Program
Private Music Lesson Form
Please fill out this form and leave it in my office mailbox (M104E) in the Music Suite,
directly across from the Performing Arts Office or email it to Prof. Joe Carter, Director,
SHU Academic Music Programs at
PLEASE NOTE: Once everything is filled out on this form and it’s left in my
mailbox or emailed to me, you will be given permission by email to register for
those lessons. This does not mean you’re registered yet. In that email will be a
contact email for the instructor. You need to bring that permission email to the
REGISTRAR in order to register for the lessons. It’s also YOUR responsibility to
contact the instructor to set up a day and time for the lessons as soon as you’ve
Date: ____________
SHU email:
Which lesson would you like to sign up for:
MU131 1 credit, ½ hour weekly lesson
MU132 2 credits, 1 hour weekly lesson
Have you previously studied with an SHU Music instructor (Yes/No)? ________
If yes, who was it?
Would you like to continue with that instructor or do you prefer to switch to another, if