Summer Studies for Music Professionals

Level 2 Registration Form & Certification Application

Print, fill-out, and submit this form to your instructor on the last day of a course, or by mail after the completion of a course.
For best results, set your page reduction to 70% or less in "page setup" to print this all on one page.

PART I: Student Information

Name_________________________________________________________________________

Address_______________________________________________________________________

City______________________________ State____ Zip_________ Phone_______________

Email (please print very clearly) _____________________________________________________

School Name or Professional Affiliation __________________________________________________

PART II: Course Transcript

Course 2A:______________________________________________________________________

Site_____________________________________________________________Date____________

Instructor____________________ Instructor Signature_____________________Date____________

Course 2B:______________________________________________________________________

Site_____________________________________________________________Date____________

Instructor____________________ Instructor Signature_____________________Date____________

Course 2C - Integrating Technology into the Music Curriculum

Site_____________________________________________________________Date____________

Instructor____________________ Instructor Signature_____________________Date____________

Part III: Fees

Please check one item from each section and write the amount on the line to the right.

Section A - Certification Fee

This is my first or second Level 2 Course. (No Fee $0)
_______
This is my third Level 2 Course. (Certification Fee $35)
_______

Section B - Membership Fee
TI:ME Membership is Required for Certification

I am currently a TI:ME Member. (Membership Already Paid: $0 due)
_______
I have been a TI:ME Member and need to renew. (Annual Membership: $40)
_______

I am currently enrolled in a TI:ME Course and I have never been a TI:ME member.
I would like the 3 month free Membership and want to become a member.
(Free & Annual Membership: $40 for 15 months)
_______

I was enrolled in a TI:ME Course in 2005 and I have never been a TI:ME member.
I would like just the 1 Month Trial Membership. (Trial Membership: $0 due)
_______
I was not enrolled in a TI:ME Course in 2005.
I have never been a member of TI:ME and want to join. (Annual Membership: $40)
_______

 
Grand Total (Amount Enclosed)
_______

Please make checks payable to TI:ME and send with this form to:
3300 Washtenaw Ave., Ste 220 Ann Arbor MI 48104

Please note: Since the Summer of 2002, there have been two paths to TI:ME Level 2 Certification.

  1. Complete TI:ME Level 1 certification then a TI:ME 2A course, a TI:ME 2B course, and TI:ME 2C.
  2. Complete five Level 2 courses including at least one TI:ME 2A course, one TI:ME 2B course, and TI:ME 2C.