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THE MUSIC ACADEMY OF NORTH CAROLINA
1327 Beaman Place, Suite 100 - Greensboro, NC 27408
Phone/(336) 379-8748 . Fax/(336) 378-6896 | REGISTRATION 20__ - 20__
Summer Trimester
Fall Trimester
Spring Trimester | | Scholarship
Consortium
Payment Plan
EC Program |
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Fill out all applicable information. Please indicate person responsible for payment in box provided. | $ |
| PARENT GUARDIAN ADULT STUDENT OTHER | Tuition |
| Parents' Names/Adult Student Name | + $ |
| Address City State Zip | Other Program(s) |
| Occupation/Company: Other Telephone(H) (W) | + $ |
| Occupation/Company: Father Telephone(H) (W) | Materials Fee/Guitar Rental |
| Occupation/Company: Mother Telephone(H) (W) | + $ |
| Email Address | Administrative Fee
(Summer/$12.50;
Fall/$25; Spring/$25) |
Please complete the following --- this demographic information is needed for grant requests. | - $ |
| 1st Student: | Credit/Discount
(Scholarships=20%; 40%; 40%) |
| Last Name First Name | + $ |
| Age Date Of Birth Grade Gender Race | Payment Plan Fee
(Summer/$10; Fall/$15;
Spring/$15) |
| Instrument Instructor | $ |
| Type of Lessons | Total Amount Due |
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Private 120 min.
Semi-Private 90 min.
Group 60 min.
Ensemble/Class 45 min.
30 min.
15 min. | Number of Lessons: Full Semester Other #
Tuition $
New Student
Continuing Student | ANNUAL BILLING OPTION
With Summer, Fall and Spring tuition payment, administrative fee is waived. |
================================================================ | SCHOLARSHIP |
2nd Student
Last Name First Name | Merit Financial Aid
Work StudyOutreach
$ |
| Age Date Of Birth Grade Gender Race | METHOD OF PAYMENT |
| Instrument Instructor | |
| Type of Lessons | If paying by check, submit this form online but mail payment to:
The Music Academy of N. C.
Attn: Financial Manager
1327 Beaman Pl., Ste. 100
Greensboro, NC 27408-8728
DO NOT MAIL CASH! Payments by cash can only be accepted in our office.
If paying by credit card, you may submit this form online and visit the secure payment section of our website to make a secure credit card payment. Alternatively, you may print this form and then enter the credit card information in the space below. The printed form with credit card information should then be mailed to the above address or faxed to the attention of our Financial Manager at (336) 378-6896. |
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Private 120 min.
Semi-Private 90 min.
Group 60 min.
Ensemble/Class 45 min.
30 min.
15 min. | Number of Lessons: Full Semester Other #
Tuition $
New Student
Continuing Student |
| How did you find out about The Music Academy? |
| PAYMENT PLAN AGREEMENT: + Payments are due 6 and 12 weeks from 1st day of semester. |
1st Pmt. Date:
| 2nd Pmt. Due+: | Final Pmt. Due +: |
| 1/3 Total Tuition $ | Total Amount Due $ | Total Amount Due $ |
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| Administrative Fee* + $ | Total Amount Paid $ | Less Scholarship % -$ |
| (Summer/$12.50;Fall/$25;Spring/$25) | Date: | (20%; 40%; 40%) |
| Payment Plan Fee + $ | | New Total $ |
| (Summer/$10;Fall/$15;Spring/$15) | | Date: |
| TOTAL: $ | + 2 payments for Summer,
3 payments for Fall and Spring. | |
I have read The Music Academy of North Carolina's policies and agree to honor them, as well as the policies of the Payment Plan Agreement.
Signature: Date:
| CREDIT CARD INFO
AmEx / MasterCard / Visa
(circle one)
Cardholder Name
Credit Card #
Expiration Date (Month/Year)
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| Recording Time | Recording Services |
| 2 Hours $ | Purpose of Recording (optional): |
| 5 Hours $ | |
| Hours $ | |
| (Cost: $53 an hour with 2-hour minimum) |
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