Payments should be mailed to:
Mountain Empire Community College
ATTN: Workforce Development – Phillips Taylor Hall
3441 Mountain Empire Road
Big Stone Gap, VA 2421

* Indicates a Required Field

Participant Information

Last Name:
*

First Name:
*

Street Address:
*

City:
*

State: *

Phone with Area Code:
*

E-Mail Address:


Age of Participant:

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Musical Experience

I wish to enroll in beginning:
Banjo Fiddle Guitar Mandolin Dulcimer Shape Note Singing

OR

I wish to enroll in intermediate:
Banjo Fiddle Guitar Mandolin Dulcimer Shape Note Singing

How long have you played?

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Scholarships

I wish to apply for a full scholarship, $150.00 (youth - 18 years)
I wish to apply for a partial scholarship, $75.00 (youth - 18 years)

Participant Scholarship Essay

In the space provided please write a paragraph telling us why you want to attend the Mountain Music School. Enter your essay in this space.

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Instruments

I wish to apply for a "loaner" instrument to use for the week:
Banjo Fiddle Guitar Mandolin Dulcimer

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T-Shirt Size

Please enter your t-shirt size including "child" or "adult":

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Diet Restrictions

Please list any diet restrictions:

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Note to Parents

If the participant is under 16 years of age, you must be present on the first day of the Mountain Music School to sign this application.

Parent(s), please enter your name(s) below


Parent's address if different from student

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That's it! Click here to apply now!