Application Instructions Please make sure to follow all instructions

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The 20 th Annual Donald A. Dake Summer Music Academies Middle School Academy: June 19-22, 2017 9:00 a.m.-noon High School Academy: June 19-23, 2017 1:00-8:00 p.m. Location: Indiana University South Bend Application Instructions Please make sure to follow all instructions Thank you for applying to the Donald A. Dake Summer Music Academy and for taking advantage of this wonderful opportunity! Applicants should complete the application and return it along with your audition recording/recording information, $25.00 deposit, and need-based scholarship request (if applicable) to the South Bend Symphony Orchestra office. All materials should be electronically submitted or postmarked no later than April 15, 2017 to secure Early Bird Tuition Rate! Materials submitted between April 16 - May 1, 2017 will secure the regular tuition rate. In order to place students in the appropriate ensembles, the applications and recordings must be submitted no later than May 1, 2017. Tuition: Middle School (grades 6-8*): Early Bird tuition: $85.00/ Regular tuition: $99.00 High School (grades 9-12): Early Bird tuition: $175/ Regular tuition: $199.00 *Current 8 th grade students may also apply for the High School Academy. These students will be placed in either the Middle School Academy or High School Academy based upon the playing level demonstrated in the audition. Mail to: South Bend Symphony Orchestra Attn: Dake Summer Academy 127 North Michigan Street South Bend, IN 46601 What to submit Make sure you include all of the following items: 1. Application Form 2. Audition Recording -- see requirements on the following page 3. Musical Résumé - listing musical accomplishments, teachers, ensembles, recitals, awards, scholarships, etc. 4. A $25.00 deposit - Checks may be made payable to South Bend Symphony Orchestra, please write Dake in the memo line. This will be applied to the tuition fee. 5. Need-based Scholarship Request (if applicable) A one page letter demonstrating need

Donald A. Dake Summer Music Academies Audition Recording Requirements All students must submit a recorded audition with your application. Recordings can be either video or audio. They may be sent via: CD, DVD, YouTube link (please make sure privacy settings allow the faculty to see it), or other electronically submitted recording. This recording will help the faculty place students in chamber ensembles. Recordings should include all the following: A scale of your choice (please perform the appropriate number of octaves for your instrument). The scale should be performed at both a slow and fast tempo. Two contrasting musical selections (each must be at least one minute in length) Examples: o A technical etude and a lyrical solo o A technical solo and a lyrical solo o A technical section and slow section of one larger work (this could be a solo or band/orchestra pieces) Please ensure that your recording can be played on a standard CD or uploaded to YouTube before you submit your application. If you choose to upload your application to YouTube, please make sure that the link is listed clearly on the application AND e-mail the link to education@southbendsymphony.org Please make sure that you put Dake YouTube Audition in the subject line. You will also need to make sure that you include your name in the e-mail. If sending a CD or DVD, please sure that your name appears on the front of the CD/DVD in permanent marker or on a CD/DVD label. If you have any questions regarding the application or the audition requirements, please contact Christina Gibson, Director of Education at 574-232-6343, or email cgibson@southbendsymphony.org

Donald A. Dake Summer Music Academies Application Form (Please Type or Print Clearly) Student Name: Instrument: Years playing your instrument: Note: students who are applying for the Middle School Academy should have a minimum of one year of playing experience. Participation in Solo and Ensemble festival or equivalent ability level is appropriate. Academy for which you are applying (please circle): High School Middle School Address: City: State: Zip: Age: Grade: Phone(s): School: E-mail(s): T-shirt size: Please indicate child or adult size (Note: The shirts tend to run large) --------------------------------------------------------------------------------------------------------------------- Private Instructor or Director Information Teacher Name: Teaching Address: City: State: Zip: Phone: E-mail:

Have you attended Dake in the past? Yes No How did you hear about South Bend Symphony Orchestra s Dake Summer Music Academy? At School Youth Symphony Private Teacher Other: Do you feel comfortable reading key signatures of 4-6 sharps/flats? Yes No Please circle the clefs that you can comfortably read: Are you applying as part of an existing ensemble (trio, quartet, etc.)? Yes No If yes, please list the other members of your ensemble that are applying for Dake: Titles of Pieces and Composers Performed for Audition: 1. 2. 3. 4. ***Please note, if you have uploaded your audition to YouTube or other media site, you will need to e-mail the links to Christina Gibson, SBSO Director of Education: education@southbendsymphony.org Scholarships Do you wish to be considered for a need-based scholarship? Yes No If yes, please include a one page letter demonstrating need. *** Please note that there will be full and partial scholarships available!

2017 Donald A. Dake Summer Music Academies Field Trip Form I, (printed name of person completing this form) of (street address) City of, State of, am the Mother Father Legal guardian (Circle one) of (child s printed name/ hereinafter child ) a minor who is age and who resides with me at the above address. I grant my child permission to participate in the 2017 Donald A. Dake Summer Chamber Academy and to accompany said Academy on a field trip opportunities during the Academy week. I understand that my child will travel by school/tour bus to and from Indiana University South Bend to the chosen performance venues. I understand that the purpose of the trip is to perform chamber music and I have instructed my child to follow any rules of conduct as directed by the Academy. In consideration of my child being able to participate in the Academy and this trip, on behalf of the child, my spouse, myself, and the child s estate, I hereby recognize that such an activity may expose the child to risks and hazards. I understand that my child may be unsupervised during the evening dinner hour and any un-coached rehearsals. I therefore release the South Bend Symphony Orchestra and the above named Academy from any and all claims, judgments, liability for any injury, whether personal or property that the child, his/her estate, my spouse now has, ever had or may have due to the child s participation in the Academy and trip, including all risks connected therewith, whether foreseen or unforeseen, during the aforementioned time periods. Signature: Date:

2017 Donald A. Dake Summer Music Academies Medical Release Form Please complete ONE of the following boxes: CONSENT TO EMERGENCY MEDICAL CARE In the event reasonable attempts to contact me or another designated adult have been unsuccessful, I hereby give my consent for: The administration of any treatment by Dr. (preferred physician and phone number) or in the event that the designated preferred practitioner is not available, by another licensed physician, and the transfer of the child to (preferred hospital) or any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians, concurring in the necessity of the surgery, are obtained before the surgery is performed. My health insurance carrier is, The following include any allergies the child may have, and medication the child may be taking, and any other facts to which a physician should be alerted: Signature: Date: OR REFUSAL TO CONSENT TO EMERGENCY MEDICAL CARE I do NOT give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the South Bend Symphony authorities to take no action, or to: I fully understand what is involved in this Academy and this field trip and the foregoing form and I understand that I have the opportunity to call the South Bend Symphony Executive Director about any questions that I may have. Signature: Date:

2017 Donald A. Dake Music Academies Media Permission Form I hereby give my permission for the use of, but not limited to, photographs, video and audio recordings of all Academy authorized activities to be used to promotions and publicity of the South Bend Symphony, its Education Programs, and the Donald A. Dake Summer Music Academy. Printed Student Name: Signature: Date: AND Printed Parent Name: Parent Signature: Date: