SOUTHERN UNIVERSITY

DEPARTMENT OF BANDS
MEMBERSHIP APPLICATION FORM

Composite ACT or SAT Score: __________

NAME: _______________________________________________ DATE: _______________

DATE OF BIRTH: ________________ SEX: _____ SS#:____________________________
HOME TELEPHONE NUMBER: (____) _______________ Cell :(____) ________________
ADDRESS: Street/City/State/Zip Code: ______________________________________________
PARENTS/GUARDIANS’NAME: __________________________________________________
ARE YOU A TRANSFER STUDENT? _________
If so, what COLLEGE/UNIV. are you transferring from? ______________________
HIGH SCHOOL ATTENDED: _____________________________________________________
NAME OF BAND DIRECTOR: ____________________________________________________
PRIMARY INSTRUMENT: _____________ SECONDARY INSTRUMENT (If Any):___________
YEARS PLAYED: _______ YEARS IN BAND: _____ HIGHEST CHAIR HELD: ____________
DO YOU OWN YOUR OWN INSTRUMENT? ____ MAKE AND MODEL: ______________________
WHEN DO YOU PLAN TO ENTER SOUTHERN UNIVERSITY? __________________(month/year)
YOU PLAN TO LIVE: (CHECK ONE) ON CAMPUS: ________ OFF CAMPUS: _____________
PROBABLE MAJOR IN COLLEGE: ________________________________________________
NOTE: BAND MEMBERSHIP IS OPEN TO ALL UNIVERSITY STUDENTS REGARDLESS
.
OF THEIR MAJOR, SEX, RELIGION, OR NATIONAL ORIGIN.

RECOMMENDED SIGNATURE OF HIGH SCHOOL BAND DIRECTOR: _______________________

UPON RECEIPT OF THIS APPPLICATION, YOUR NAME WILL BE PLACED ON OUR MAILING
LIST SO THAT YOU MAY RECEIVE ADDITIONAL INFORMATION REGARDING AUDITION AND
PRE BAND CAMP.

SIGNATURE OF APPLICANT: __________________________________ DATE: __________

PLEASE SEND APPLICATION TO LAWRENCE JACKSON, DIRECTOR OF BANDS, P.O.

BOX 9621, SOUTHERN UNIVERSITY, BATON ROUGE, LA 70813. BAND DEPARTMENT
PHONE NUMBER (225) 771-3528, FAX NUMBER: (225) 771-4075