DIPLOMA IN MUSIC PERFORMANCE 2015 APPLICATION FORM & TAX INVOICE Candidate information
Transcription
DIPLOMA IN MUSIC PERFORMANCE 2015 APPLICATION FORM & TAX INVOICE Candidate information
No stapled cheques please DIPLOMA IN MUSIC PERFORMANCE (DipABRSM & LRSM) 2015 APPLICATION FORM & TAX INVOICE Candidate information Candidate number (if applicable) Title Family name First name Qualifications Male Female Address Home telephone ( ) Suburb Work telephone ( ) City/Town Fax ( ) Post code Mobile telephone ( ) Email Date of birth Identification Passport Driving licence. A photocopy must be enclosed with this form Alternative contact person If the candidate is under 16 years of age, or if someone other than the candidate should be contacted regarding this application, please provide the details below. Name _____________________________________________________ Email _________________________________ Phone ___________________ Examination options DipABRSM LRSM Please check that you have fulfilled the necessary prerequisites – see page 20 of the syllabus. A photocopy of the necessary documentation must be enclosed with this form. If you wish to sit an FRSM exam, or if you plan to take a specialist option (e.g. chamber music), please contact the ABRSM office to request the appropriate application form. Instrument ______________________________________________ This is the first time I have entered this exam I have entered this exam before and would like to retake the complete exam I have entered this exam before and would like to retake only part(s) of the exam – Exam session: Performance Viva Voce and Programme Notes Quick Study Diploma 1 Closing date: 13 March. Exams: 11 May to 3 July Diploma 2 Closing date: 7 August. Exams: 19 October to 4 December Town/city: __________________________________________________ Specific needs (e.g. visual or hearing impairment, dyslexia, or other considerations) ________________________________________________________ If you would prefer your exam to be scheduled early or late in the session, or have other comments regarding your availability, please write the details here: _____________________________________________________________________________________________________________________________ We cannot guarantee to meet any date requests. Payment Complete exam: DipABRSM – $500 LRSM – $1510 Partial retake: Please contact the ABRSM office to request the retake fee applicable to your exam and complete the amount below. Payment Options (tick all that apply) Cheque Enclose cheque(s) made out to ABRSM with this form Online Date paid______________ Transfer fees to ANZ account 06 0115 0109313 02 $ _____________________ • Particulars – Diploma • Code – Exam town or city • Reference – Candidate name and include the information below: GST No. 30-296-524 Declaration I have read and undertake to abide by the regulations in the current Diploma Syllabus. Candidate signature: _________________________________________ Date: _____________________ If the candidate is under 16 years of age, this declaration must also be signed by a parent or guardian. Parent/guardian signature: ____________________________________ Date: _____________________ Check list All details in this form are complete and correct A copy of the identification document (e.g. passport or drivers licence) is enclosed A copy of the prerequisite documentation is enclosed A cheque payment is enclosed or the fee has been paid online Send your form and other documents to either your local representative or to the ABRSM office (details below) to reach us before the closing date for your exam session. Once your application has been received, you may be asked to provide further information. You will then receive your appointment notice about three weeks after the closing date. After your exam, the examiner’s report and a recording of your exam will be sent to London for moderation. The results are then sent back to New Zealand. This process will take around eight weeks. PO Box 34433, Birkenhead, Auckland 0746 129A Onewa Road, Northcote, Auckland telephone (09) 480 1200 ■ freephone 0800 MUSEXAM (0800 687 392) ■ fax (09) 480 1201 text 02 ABRSM 200 ■ email offi[email protected] ■ web www.abrsm.org/nz Candidate declaration form Do not send this page with your application. Complete the details below and give it to the examiner(s) at the start of your exam. Declaration – I confirm that I have read the regulations in the current Diploma Syllabus and that: • The attached Programme Notes are genuinely my work and I am the sole author • They have not previously been submitted to ABRSM or to any other institution or agency for another academic award • The sources used and quoted are properly acknowledged and listed • I have read the section on plagiarism below and understand that I will be penalised or disqualified if a charge of plagiarism is upheld Signature: _______________________________________ Date: _____________________ ABRSM defines plagiarism as an attempt to pass off as one’s own the work of others. Thus copying from a printed or unprinted source without acknowledging it, or constructing a précis of someone else’s writing without citing indebtedness to that writer, constitutes plagiarism. In preparing the Programme Notes candidates are encouraged and expected to read widely to demonstrate the breadth of their reading and, where appropriate, to quote the work of others. However, such quotations and references must be properly and fully attributed in accordance with the advice provided by ABRSM. Candidates who ignore this advice run the risk of being accused of plagiarism. The Chief Examiner will refer any suspected cases of plagiarism to the Diploma Board. The Diploma Board may disqualify a candidate if the charge of plagiarism is upheld. Candidates will have a right of appeal and representation if such charges are made. PO Box 34433, Birkenhead, Auckland 0746 129A Onewa Road, Northcote, Auckland telephone (09) 480 1200 ■ freephone 0800 MUSEXAM (0800 687 392) ■ fax (09) 480 1201 text 02 ABRSM 200 ■ email offi[email protected] ■ web www.abrsm.org/nz