Layout

Program Application

Thank you for your interest in the UC San Diego Jazz Camp Program at UC San Diego Extension. To apply, please complete the application form below. Upon acceptance, you will receive additional directions for registration from our staff. Should you experience difficulties with this form, contact us immediately and we will assist you in completing the application.

Domestic students must be at least 14 years old to participate in the UC San Diego Jazz Camp program. International students must be at least 18 years old to participate.

(* indicates required fields)

Personal Information

First Name*

Middle Name

Last Name*

Country:*

Street Address*

City*

Province or state and postal code*

State*

Postal Code*

Company (if applicable)

Email Address*

Confirm Email Address*

Date of Birth

Gender:*

Preferred Phone Number* () - x	Phone Type* Home Business Cell
Alternate Phone Number* () - x	Phone Type* Home Business Cell

Secondary Education

List the highest secondary education level you have completed.

School Name*

Grade Completed*

Type of School*

Completion Date*
//

GPA*

College & Post Secondary

List any undergraduate/graduate work you have taken.

Field of Study

Institution

Degree

GPA

Status

Graduation Date
//

Field of Study

Institution

Degree

GPA

Status

Graduation Date
//

Field of Study

Institution

Degree

GPA

Status

Graduation Date
//

Field of Study

Institution

Degree

GPA

Status

Graduation Date
//

Emergency Contact

First Name*

Last Name*

Relationship*

Street Address*

City*

State*

Postal Code*

Email Address*

Confirm Email Address*

Preferred Phone Number* () - x	Phone Type* Home Business Cell
Alternate Phone Number* () - x	Phone Type* Home Business Cell

Housing and Meals

On-campus housing is available in the dorms on the UCSD campus.

Would you like to stay on campus?*
Yes No

If you know someone who will be attending Jazz Camp, you may request them as a roommate. Otherwise one will be assigned to you.
Requested roommate's name

List any restrictions regarding food and diet.

1000 character(s) remaining.

Specify any health problems, allergies or disabilities.

1000 character(s) remaining.

Placement Information

Video URL (all instruments)* Note: An audio/video recording is required. For all instruments except drums, the student should play the melody, then improvise on two choruses of a jazz standard or 12-bar blues. Drummers should play brief (approx. 1 minute) examples of the following four rhythms: swing, 3/4 jazz waltz, bossa nova, 6/8 Latin.
What is your primary instrument?*	How many years have you played this instrument?*
What is your second instrument?	How many years have you played this instrument?

Briefly describe your musical background and past experience in playing jazz. What is the level of your sightreading? Have you performed in an ensemble? For how long? Have you soloed in an ensemble? Please be specific.*

2000 character(s) remaining.

Rate your interest in different jazz styles (1 lowest, 5 highest):

Open Form*

Bebop/Mainstream*

Hard Bop*

Who is your preferred faculty member for a private lesson? If no preference, type in NP:

Instructor 1*

Instructor 2*

Certification and Authorization

I affirm that all of the information on this application is true and complete to the best of my knowledge. I have reviewed the policies and procedures for the UCSD Jazz Camp Summer program.

(applicant)

Tuition includes a non-refundable $125 fee. The full tuition fee is due upon acceptance into the program.