Teacher Training Program Application

Teacher Training Program Application
Date............................... Last Name.............................................................. First Name.......................................................
Name you like to be called (if different than First Name)..................................................................................................
Address......................................................................................................................................................................................
City............................................................ State/Prov................ Zip/Post/Postal Code..................... Country................
Telephone (day)............................... Telephone (evening)............................... Mobile/Cell Phone.................................
Email.................................................................................................................... Date of Birth...............................................
Please carefully read the next section, and on the following pages, provide a clear response to each:
• Are you a music educator?
• Are you a member of a music teacher organization, i.e., ECMMA, AOSA?
• Briefly describe your background as it relates to music. Include anything that you feel is relevant.
• Exactly how did you come to find out about the Simply Music Rhapsody program?
• Why do you wish to participate in the Simply Music Rhapsody Teacher Training Program?
• What do you believe will be the most significant challenges you face in becoming a Simply Music Rhapsody Teacher?
• Is there anything that we should know about, that you have a responsibility to communicate, that would assist us in
supporting you, and/or impact our decision to grant you a License to teach the Simply Music Rhapsody method?
This might include information about certain illnesses, circumstances, conditions, convictions etc., or anything
else you feel is relevant. If you have nothing to communicate regarding this, you will need to clearly state so as
part of your answer.
• Was there a Simply Music or Music Rhapsody teacher instrumental in your decision to take the Teacher Training
program? If so, please let us know who they are.
Please send this form, as well as your payment to the Head Office relative to your country of residence:
USA & Canada
Simply Music
PO Box 160663
Sacramento, California
USA 95816
AUS & NZ
Simply Music
PO Box 142
Darling South, Victoria
Australia 95816
Signed: ..............................................................................................................................
(Applicant)
(022812)
..............................................................................................................................
(Parent to sign as well, if applicant is under 18 years of age)
Simply Music Rhapsody: Teacher Training Program Application | © 2012 Simply Music. All rights reserved.
Page 1 of 4
Teacher Training Program Application
(022812)
Simply Music Rhapsody: Teacher Training Program Application | © 2012 Simply Music. All rights reserved.
Page 2 of 4
Teacher Training Program Application
(022812)
Simply Music Rhapsody: Teacher Training Program Application | © 2012 Simply Music. All rights reserved.
Page 3 of 4
Teacher Training Program Application
(022812)
Simply Music Rhapsody: Teacher Training Program Application | © 2012 Simply Music. All rights reserved.
Page 4 of 4