Araya Piano Studio


New Student Interview Sheet

Please use this format, copy & paste,  to answer questions then mail, e-mail, or fax to Araya Piano
Studio
.  If you prefer applying online, please click the following page:
https://spreadsheets.google.com/viewform?formkey=dDFESm9aeGlHTUUtZjVFRlBPR3lUTGc6MQ

e-mail:  arayu8@yahoo.com
fax:  03-5809-1305

(Personal information will be kept in strict confidence.)


1.  Today's Date:

2.  Parent's name (if student is under 18):   

3.  Student's name:

4.  Student's age (if under 18):

5.  Student's address:



6.  Phone number to reach student:

7.  E-mail address to reach student:

8.  Billing Address (if different from 5):



9.  Where would you like to take piano lessons?:  

    1)  In my home
    2)  In teacher's home
    3)  Other place

10.  Please list preferred lesson times.  (i.e. Monday, 4~8 p.m., All day on Saturday)

    1)

    2)

    3)

11.  How long have you taken piano lessons?:           year (s)          month (s)

12.  Was there any interruption in the history of your piano lessons?:

13.  In which level do you think you belong?:

    1)  Haven't learned piano yet
    2)  Beginner's level
    3)  Intermediate level (Sonatina, Invention or some Sonata level)
    4)  Advanced level
    5)  Not known

14.  If you are in beginner's level, which method are you using?:

    1)  Bastien     What Level?
    2)  Alfred's     What Level?
    3)  Faber       What Level?

15.  If you are intermediate level, which method are you using?:

16.  Do YOU (student, NOT parents) want to learn piano?:        Yes        No

17.  Do you have a piano at home?:

    1)  Acoustic vertical piano
    2)  Acoustic grand piano
    3)  Electric 88 key piano with pedals
    4)  Electric keyboard without pedals
    5)  No, I don't.

18.  What is your purpose of taking piano lessons?  Please mark as many as you like.

    1)  I want to be a concert pianist.
    2)  I want to be a piano teacher.
    3)  I want to be a college piano major.
    4)  I want to go to an Arts Magnet High School.
    5)  I want to attend a local piano competition.
    6)  As a part of music education
    7)  Pleasure
    8)  I want to learn how to teach piano to my child.
    9)  Other:

19.  Would you like to learn popular music?:         Yes        No

20.  Do you play other musical instruments?:        Yes        No        Which instrument?:

21.  Do you have a mental / physical handicap which may affect piano lessons?:     Yes      No

    If you answered "Yes", please describe:

22.  Do you expect something specific from your new piano lessons?:

23.  Do you have other things to tell your new piano teacher?  (Questions will be answered at an
interview session.):

24.  Which place would you like to have the meeting?

   1)  In Teacher's Studio
   2)  In Student's Home

25.  Please list possible date and time for the free meeting below so that teacher can choose.
Please give about 5 possible slots:




Thank You  

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