Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone *

(###)

###

####

Secondary Phone

(###)

###

####

What styles do you teach on your Primary Instrument? *

(Check all that apply)

Bluegrass

Blues

Celtic

Classical

Country

Folk

Funk

Fusion

Gospel

Heavy Metal

Hip Hop

Indian

Jazz

Klezmer

Latin

Musical Theatre

Opera

Pop

R&B

Rock

Rockabilly

Slide Guitar

What styles do you teach on your Secondary Instrument?

(Check all that apply)

Bluegrass

Blues

Celtic

Classical

Country

Folk

Funk

Fusion

Gospel

Heavy Metal

Hip Hop

Indian

Jazz

Klezmer

Latin

Musical Theatre

Opera

Pop

R&B

Rock

Rockabilly

Slide Guitar

What styles do you teach on your Third Instrument?

(Check all that apply)

Bluegrass

Blues

Celtic

Classical

Country

Folk

Funk

Fusion

Gospel

Heavy Metal

Hip Hop

Indian

Jazz

Klezmer

Latin

Musical Theatre

Opera

Pop

R&B

Rock

Rockabilly

Slide Guitar

What styles do you teach on your Forth Instrument?

(Check all that apply)

Bluegrass

Blues

Celtic

Classical

Country

Folk

Funk

Fusion

Gospel

Heavy Metal

Hip Hop

Indian

Jazz

Klezmer

Latin

Musical Theatre

Opera

Pop

R&B

Rock

Rockabilly

Slide Guitar

Do you have a car? *

Yes

No

Do you have a studio that you teach from? *

Yes

No

What age students do you teach? *

Elementary School

Pre-teen

Teenage

Adult

What subjects do you teach? *

(Check all that apply)

Harmony

Theory

Ear Training

Songwriting

Arranging

Orchestration

Jazz Music History

Music Technology

Classical Music History

Rock Music History

Do you currently teach for any other companies? *

Yes

No

Are you currently working on a music degree? *

Yes

No

Have you ever been convicted of a felony? *

Yes

No

If you are retained to provide services as a contractor for Elite Music Instruction, do you give Elite Music Instruction permission to run a FCRA compliant background check on you? *

This includes some or all of the following: County and State Criminal Records, SSN Verification, Address History, Sexual Offender Registry and OFAC exclusion Database. You will receive a copy of the background check. PLEASE NOTE: This is a requirement

Yes, I give Elite Music Instruction permission to run a FCRA compliant background check on me

By checking this box, *

I hereby attest that all the information I have provided on this application is true.