Shepherd University Department of Music

Shepherd University Department of Music Preparatory Division Request to perform on Recital, April 29, 2017

Turn in to Room 118 Sherry Sykes, Coordinator for Preparatory Division By April 15, 2017 (please type or print clearly)

Recital Date: Saturday, April 29, 2017

Recital Times: 10:00am 11:30am Please circle first choice

Name of Student: ______

Name of Instrument: ______

Name of Instructor: ______

Work to be Performed: ______

______Estimated length of piece to be performed: ______Is the student: beginner, intermediate, advanced? ______

Please be specific, List movement of piece, composer, birth and death dates of composer. ****Length of Performance cannot exceed 5 minutes without permission from instructor and Prep. Coordinator.

______Student signature Date

______Parent signature Date

______Instructor signature Date