International Music Academy Pilsen, Czech Republic

APPLICATION FORM

download Application Form MS Word or Adobe Acrobat

LAST NAME

FIRST NAME

ADDRESS

NATIONALITY

GENDER

DATE OF BIRTH & AGE

INSTRUMENT

E-MAIL ADDRESS

HOME TELEPHONE

CELL PHONE

PRESENT SCHOOL OF MUSIC

TEACHER NAME

TEACHER ADDRESS

IMAP TEACHER CHOICE

HOW DID YOU HEAR ABOUT US?
(website, friend, teacher, brochure, other)

Notification of acceptance begins 1 March, 2010
All new students are required to send in an audition CD/DVD or U tube performance.
String players: choose a mvt of a concerto and solo Bach.
Pianists: repertoire is your choice.

FEES:

APPLICATION FEE:	$75 USD
FULL COURSE TUITION:	$2000 USD	(Includes cell phone and tram card)
PARTIAL COURSE TUITION:	$600 USD	per weeks
($15/week tram card, $20/week cell phone, $25/week Czech health insurance – OPTIONAL)
CZECH HEALTH INSURANCE:	$100 USD	for full course

Circle the weeks you would like to attend:

I :

II :

III :

IV:

CHOICE OF IMAP TEACHER:

STUDENT ACCOMODATION:

Full 4 week course:

Dormitory:

$500 USD for full 4 week course (single occupancy for string players, double occupancy for pianists)
$150 USD per week for partial course
$180 USD breakfast for full course, buffet style Mon-Sat
$45 USD breakfast per week, buffet style Mon-Sat

Send application, (you may email the application), recording and fees to:
Teri Shipps, Admissions Coordinator, International Music Academy Pilsen

3098 Cross Creek Court, Ann Arbor, MI 48108 USA
Tel/fax: 1-734-222-8009 imapadmissions@gmail.com
Checks must be drawn on a US Bank in USD and made out to: International Music Academy Pilsen

download Application Form MS Word or Adobe Acrobat

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