rev. 7/12
TWU Department of Music & Drama
Non-Music Majors and Music Majors on a Secondary Instrument
Private Music Lesson Request Form
This form is to be completed each semester in order to obtain permission to register for
private lessons by non-music majors and by music majors on a secondary instrument
(this form is NOT required for music majors for lessons on their primary
instrument.) Instructor availability is limited and cannot be guaranteed.
Student name:
Address:
TWU ID #: Phone #:
E-mail:
I am majoring in:
Advisor’s name:
Advisor’s phone:
I wish to register for private music lessons on (indicate name of instrument or voice):
during the (indicate semester and year) semester.
Course #:
I (click box to select) have have not taken lessons on this instrument for credit
previously at TWU. If so, how many times?
During which semester(s)?
Name of instructor:
Experience on this instrument other than lessons indicated above:
Have you performed, or do you intend to perform, in any TWU ensembles? If so, please
specify which ensemble and when:
Student signature:__________________________ Date:_________________________
Request approved: Request not approved:
Music Dept. Chair signature: Date:
Return this form to:
Dr. Pamela Youngblood, Chair, Dept. of Music & Drama, Music Bldg. Rm. 114
