Request for Information

Thank you for your interest in CIM's Preparatory Department! Please complete the form below. Upon submission, you will receive an email with additional information about CIM's Preparatory offerings.

All inquiries for students under the age of 18 must list one parent/guardian's information.

If you are submitting this form for another person, you will be required to indicate your relationship to the student.

* Denotes a Required Field

Student First Name*

Student Last Name*

Student Email Address*

Student Primary Phone Number

Student Date of Birth*

Please select the student type*

Are you submitting this form for yourself, or another person?

Please select your relationship to the student*

Please describe your relationship to the student*

Form Submitter First Name*

Form Submitter Last Name*

Form Submitter Email*

Form Submitter Phone

Student Current Grade

Current School Attending

Please select your relationship to the student*:

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email Address*

Parent/Guardian Phone Number

Mailing Address

Country
Street
City
Region
Postal Code

Desired Entry Term*

Instrument 1*

Instrument 2 (optional)

Instrument 3 (optional)

How did you hear about us?*