First Name:*  House of Rock + V2
Last Name:* 
Age:* 
If under 18, Parent or Guardian Name:* 
Address:* 
 
City:* 
State:* 
Zip Code:* 
E-mail Address:* 
Confirm E-mail Address:* 
Cell Phone:* (If under 18, enter phone for Parent or Guardian.)
Home Phone: 
Work Phone: 
Best time to call you:* 
Previous Music Experience:
Please give a brief history of your music background. If no previous background simply leave this box blank
Application Essay:*
Why should Rock Star University Instructors accept you as a Rock Star University student?
Are there any days of the week you are NOT available for rock music lessons?*





What is your preferred lesson times?*


What is your instrument of choice?*




Provide your credit card information below for payment in full to schedule your private rock music interview and assessment with Rock Star University's Instructional staff. You will then be contacted by Rock Star University's Admissions Director who will schedule your personal and private music assessment interview.

Payment Details:
Cardholder's Name:* 
Card Number:* 
Expiration Date (mm/yy):* 

I UNDERSTAND I am applying for acceptance into Rock Star University and that not every student who applies is accepted. I further understand and agree that the $100 application fee is non-refundable and non-transferable upon submitting this application. I further understand that during my personal and private Rock Star University interview I will meet with EACH of Rock Star University's specialized instructors for approximately 30 minutes at a time. EACH of Rock Star University's rock music teachers will assess my musical abilities to determine my current musical potential for rock guitar, rock drums, rock keyboards, and rock voice, with the purpose of determining how to best capitalize on my natural strengths and talents. I further understand after my personal and private interview and musical assessment is completed, Rock Star University's instructors will provide their recommendations to Rock Star University's Admissions Director, who will then schedule a meeting with me to discuss the results of my assessment and either offer me acceptance into Rock Star University or make recommendations appropriate to the results of my interview and assessment. I reiterate my understanding and agreement, that whether I am offered acceptance into Rock Star University or not, my $100 application fee is non-refundable.

I authorize Rock Star University to charge my credit card $100 to complete my Rock Star University Application

Press the Submit button only ONCE to send securely.

Rock Star University does not accept every rock music instruction applicant, but if you are accepted by Rock Star University's music teachers, within one year of rock music instruction, YOU WILL ROCK!

* = Required