Lower Dauphin HS Instrumental Music Private Lesson Verification Form

Keith Richardson, Director of Bands-

STUDENT NAME: ______

INSTRUMENT: ______GRADE: ______

MARKING PERIOD TO WHICH THESE LESSONS ARE TO BE APPLIED: 1 2 3 4

(circle one)

Private Teacher’s Name: ______

Private Teacher’s Contact Info: (phone or email) ______

To the private teacher: The student submitting this form has elected to substitute their private lessons with you for their required in-school lessons. I appreciate your taking the time to fill out this form. Please do so honestly and frankly. Should you have any concerns regarding this process or reservations in offering feedback, please feel free to contact me at your convenience.

Lesson Dates (may be filled out by student):

1. ______2. ______3. ______

4. ______5. ______6. ______

Please briefly report on the student’s progress in the following areas (circle the applicable descriptor):

Attitude: / Excellent / Good / Acceptable / Poor
Progress: / Excellent / Good / Acceptable / Poor
Effort: / Excellent / Good / Acceptable / Poor
Attendance: / Excellent / Good / Acceptable / Poor

On the back of this page, the student should list the scales, exercises, solos, and/or etudes that were studied during this marking period. The form will not be accepted without this information.

Private Teacher Signature:
Student Signature:
Parent Signature: