COLORADO STATE UNIVERSITY FOR SEMESTER: FALL SPRING

SCHOOL OF MUSIC, THEATRE, AND DANCE

COLLABORATIVE PIANIST REQUEST FORM TODAY’S DATE: ___ / ___ / 20___

Direcons: Complete the following form, providing as much of the requested informaon as possible. Then submit this
form in person to the Supervisor of Accompanying at UCA 314A, or via email at: m.burns@colostate.edu. For infor-
maon on request procedures and deadlines, please contact the Supervisor of Accompanying.

NAME: INSTRUMENT:

INSTRUCTOR NAME: LESSON TIME / DAY:

EVENT TYPE (CHECK ONE): FULL RECITAL HALF RECITAL JURY OTHER (PLEASE SPECIFY): __________________

EVENT DATE / TIME:

Please provide the best way to contact you:

EMAIL: PHONE: - -

Please list your planned repertoire below (include composer, complete tle, opus, and movements):

List any addional pieces on the reverse of this form. (See Page 2)

SPECIAL REQUESTS:

To be completed by the Supervisor of Piano Accompanying—do not write below this line:

PIANIST NAME: HOURS APPROVED:

EMAIL: PHONE:

SIGNED: APPROVAL DATE: ___ / ___ / 20___

If re-approved or amended, check this box:

PAGE 1 Form Rev. 12/2018

STAFF PIANIST REQUEST FORM

Please list any addional repertoire below (include composer, complete tle, opus, and movements):

PAGE 2