UM Jazz Workshop Application Form

Please apply for the UM Jazz Workshop by completing the following form.

Application form for the UM Jazz Workshop, a jazz education project of the University of Mississippi Department of Music for middle and high school-aged students.

Student Name * Required
First and last name of the student to be enrolled.
Student's age * Required
Instrument * Required
Student's grade * Required
Student's school name * Required
Name of student's band director (or private teacher) * Required
Name of parent or guardian * Required
Parent or guardian phone number * Required
Parent email address * Required
Parent email is required. If the student would also like to receive emails, please enter his or her address, as well.
Permission to use student's name/likeness for promotion & other purposes * Required
I, the guardian, give permission to the University of Mississippi to use the name and likeness of this student for promotional and other related purposes, including photographs and/or video.