Julia Henry

Information Sheet

Students Name ________________________________________________ Age ______

Grade __________ School __________________________________________________

Contact Information
Parents Name _______________________________ Relationship to Student _____________
Address _____________________________________ Email Address ___________________
Home Phone ______________________ Cell Phone _______________________
Parents Name _________________________________ Relationship to Student ____________
Address _____________________________________ Email Address ___________________
Home Phone ______________________ Cell Phone _______________________
Who Referred you? ____________________________________________________________

Times available for Lessons

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Any previous piano experience? __________________________________________________

____________________________________________________________________________
Is there anyone in your family that plays piano? ______________________________________
____________________________________________________________________________
What type of piano is there at home to practice on? ___________________________________
____________________________________________________________________________
Other Activities/Hobbies? _______________________________________________________
____________________________________________________________________________

Transfer Student
How many years have you studied? ________________________________________
Past Teacher and reason for transferring ____________________________________
_____________________________________________________________________
How many previous piano teachers have you had? ____________________________
_____________________________________________________________________
What were the books you studied out of? Also books you're currently using? ________
_____________________________________________________________________
_____________________________________________________________________

Julia Henry
Students name ____________

Beginner Activity Sheet

Date _____________

2
3
4
5
1) Repertoire Play Something 1
____________________________________________________________________________
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Rote Song/ Work with them 1
2
3
4
5
____________________________________________________________________________
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2) Keyboard Topography
1
2
3
4
5
____________________________________________________________________________
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3) Rhythm
1
2
3
4
5
____________________________________________________________________________
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4) Ear Training
1
2
3
4
5
____________________________________________________________________________
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5) Technique (sight-reading) 1
2
3
4
5
____________________________________________________________________________
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Notes:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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Transfer Activity Sheet

Students name _______________

Date ______________

2
3
4
5
1) Repetoire 1
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Mini Lesson Work with them
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
2) Scales 1

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
3) Sight Reading 1

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
4) Theory 1

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

5. Improv

____________________________________________________________________________
____________________________________________________________________________
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Notes:
____________________________________________________________________________
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