DanceABLE Scholarship Application Form

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We appreciate you filling out the questions below to provide your student with the best experience possible and to be prepared to meet their individual needs. Contact information should be for whomever we will reach out to register the student for classes.

Email *

Student Name

Parent/Guardian Name

Phone

Address

Gender

Female

Male

Non-Binary

Prefer not to say

Clear selection

Age (Range)

Under 12

12-18

19-45

45-60

Over 55

Clear selection

Ethnicity (for statistical purposes)

Caucasian

Hispanic

African American

Asian/Pacific Islander

Multiracial

Indian/Alaskan Native

Other

Clear selection

Household Income

Under $10,000

$10,000-$30,000

$30,000-$70,000

$70,000-$100,000

$100,000-$250,000

$250,000 & Above

Prefer not to Answer

Clear selection

Type of Disability

Physical

Cognitive/Intellectual

Both

Clear selection

Does the student need any accommodations? Please explain.

Does the student use any personal devices? Please explain.

What is the student's preferred mode of communication?

This scholarship opportunity is funded by AWS Foundation.

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