Apply For The Scholarship Today
(Must Meet Guidelines)
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Students First and Last Name
Address
City
State, Zip Code
Area Code Telephone Number
Date of Birth
Please State Your Age
2.5 yr only for Creative Movement
3 yr only for Creative Movement
4 yr
5 yr
6 yr
7 yr
8 yr
9 yr
10 yr
11 yr
12 yr
13 yr
14 yr
15 yr
16 yr
17 yr
18 yr
Gender
Female
Male
Parents First & Last Name
How Did You Hear About Us?
How Did You Hear About Us?
Internet
Local Ad
Friend
Agency
Day Care
Director
Other
Who Referred You?
Boys And Girls Club
Children Of Promise
Big Brother Big Sister Program
Lodi Rec
Von King Herbert Cultural Arts
Director Personally
Other
What Type Of Class Would You Be Using The Scholarship For?
Dance
Drama
Singing
Mentoring Through Dance
Parents Employer
Employer Telephone Number
Other Sources of Income
Self Employed
Public Assistance
Unemployment
SSI/Disabilty
House Hold Size
Salary Range
Below-$15,000
$16,000-$20,000
$21,000-$30,000
$31,000-$40,000
$41,000-Above
Email Address
Please Write Briefly What Dance Means to you?
What Program are you applying for?
Teen Mentoring Thur Dance Girls Brooklyn Location
Teen Mentoring Thur Dance Girls Hackensack/Lodi
Teen All Boys Workshop
Contemporary Ballet Program 7-12 yrs old
Hip Hop/Jazz Program 6-12 yrs old
All information will remain confidential
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