New Student Inquiry

Graduate Music Education New Student Form

By filling out this form, you will help us best serve your specific interests in the Graduate Music Education Program at Gordon College.

The Program Coordinator for Graduate Music Education will be in touch with you within 48-72 hours of your inquiry submission to discuss your educational goals, and the opportunities that are available to you at Gordon.

1. First Name

2. Last Name

3. Maiden/Birth Name

4. Date of Birth

5. Gender

	Male
	Female

6. Mobile/cell number

7. email address

8. Permanent Address (Street)

9. Permanent Address (City, State, Zip)

10. Home phone #

11. Anticipated Academic Enrollment Year (Academic Year is September-August)

	2015-2016
	2016-2017
	2017-2018

12. Teaching License Currently Held

	Preliminary/Provisional
	Initial
	Professional
	No license

13. State teaching license is held in

14. Programs of Interest and Degree/License sought

	Post Baccalaureate / Initial License in Music
	Master of Music Education / Professional License in Music
	12 Credit Approved Program / Professional License in Music
	Non-Degree (graduate courses for credit or professional development, no formal program enrollment)
	Summer Music Education Workshops (for graduate credit or PDPs)

15. Music area currently teaching in (choose all that apply)

	General Music
	Instrumental Music
	Choral Music
	Orchestra/Strings
	Private Instruction

16. Certificate Levels Currently Held

	Orff
	Kodaly
	Dalcroze
	Music Learning Theory
	Suzuki

17. Were you previously enrolled in graduate courses, undergraduate courses, or professional development workshops at Gordon College?

	Yes
	No

18. College/University where undergraduate degree was earned

19. What degree have you earned at this institution?

20. What was your undergraduate major?

21. If you have done graduate work, what institution did you attend?

22. Did you graduate from this institution?

	Yes
	No

23. What degree have you earned at this institution?

24. Place of Work

25. Work Address:

26. Current Position of Employment

27. Grade levels currently teaching if applicable

28. How did you hear about Gordon's Graduate Music Education Program? (choose all that apply)

	Personal referral
	Through my school district/work
	Flyer/Brochure
	Magazine/Newspaper/Publication
	Received information in the mail
	Received information via email
	Internet search
	Radio
	During my undergraduate program

29. Please specify source (name of person, publication, website, etc.)

30. What influenced you to consider attending Gordon?

	Friend, colleague, family member attended
	Convenient class meeting times
	Reputation of the faculty/program
	Convenient Location
	Program will provide career advancement/change
	Cost/affordability
	Personal attention and service

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978 927 2300 | admissions@gordon.edu | info@gordon.edu

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