Whitlock Senior Award

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This form may be submitted November 1 - May 1 for eligible senior students.

Use the tab key or mouse to move between answer fields.  Using the Enter key will submit your form.

Student Information

Last Name

First Name

Address

City

State

Zip Code

Phone Number

Student/Parent Email

Digital Photo

Size limit 2.7 MB

Instructions

Submit one form per student.  If you have more than one entry, use the back arrow on your browser after you see the confirmation page.  This will return you to the form.

Teacher Information

Teacher Name

NCTM

Check if certified

Address

City

State

Zip Code

Association

*Teacher Email

Valid email is required

Important: Enter a valid e-mail address. Receipts will be sent to this address.

Whitlock Points

Beside each activity in which the applicant participated, select the appropriate grade and/or award level(s).  Point totals are listed within each section.  You will need to enter the total score received for each category in the `Total Points` area for that category.  The overall total will be calculated using these numbers.

Theory

Grade 9

Grade 10

Grade 11

Grade 12

Theory Point Total

World of Music

Grade 9 Medal: 30 points

Grade 10 Medal: 30 points

Grade 11 Medal: 30 points

Grade 12 Medal: 30 points

WOM Point Total

Did you participate in TMTA SA Original Composition?

Yes
No

Select all categories that apply.

Solo

9th Grade Solo

10th Grade Solo

11th Grade Solo

12th Grade Solo

Solo Point Total

Ensemble

9th Grade Ensemble

10th Grade Ensemble

11th Grade Ensemble

12th Grade Ensemble

Ensemble Point Total

Large Ensemble

9th Grade Large Ensemble

10th Grade Large Ensemble

11th Grade Large Ensemble

12th Grade Large Ensemble

Large Ensemble Point Total

Publication

9th Grade

10th Grade

11th Grade

12th Grade

Publication Point Total

TMTA SA Performance Contests: State Level Only

Did you participate in TMTA Performance?

Yes
No

Select all categories that apply

9th Grade Solo

10th Grade Solo

11th Grade Solo

12th Grade Solo

9th Grade Concerto

10th Grade Concerto

11th Grade Concerto

12th Grade Concerto

Performance Point Total

Did you participate in MTNA/TMTA Composition?

Yes
No

MTNA/TMTA Composition Competition  
  
State Winner   50 points   
1st Runner-up          30 points   
Honorable Mention  20 points   
Division Winner  75 points   
1st Runner-up          50 points   
Honorable Mention  30 points   
National Winner  100 points   
Honorable Mention  50 points

List all levels achieved, such as `State Winner, Division 1st Runner-up.`

9th Grade

10th Grade

11th Grade

12th Grade

MTNA Composition Point Total

Did you participate in MTNA/TMTA Performance?

Yes
No

MTNA/TMTA Performance Competition   
   
State Winner   50 points    
1st Runner-up  30 points    
Honorable Mention  20 points    
Division Winner  75 points    
1st Runner-up          50 points    
Honorable Mention  30 points    
National Winner  100 points    
Honorable Mention  50 points

List all levels achieved, such as `State Winner, Division 1st Runner-up.`

9th Grade

10th Grade

11th Grade

12th Grade

MTNA Performance Point Total

Total Points

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