DANCE MEDICINE MENTORSHIP APPLICATION

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Thank you so much for your interest in joining this 8 week program! Please fill out this application and you will be notified of acceptance no later than March 21st. Further instructions for payment & accessing your course will be emailed to you at that time. Thanks and I hope to meet you really soon!

Email *

First and Last Name *

State/country you are located *

What is your profession (check all that apply) *

Physical Therapist

Physical Therapy Assistant

Physical Therapy student

Other:

Required

What school did you/do you currently attend? *

When did you graduate or when will you graduate? *

Have you ever worked with dancers? If so, what was your role? *

How many years of experience do you have working with dancers? *

1-3 years

3-5 years

>5 years

What are your goals for participating in this mentorship program? *

Do you have interest in eventually starting your own Dance Medicine practice (full time or side hustle) in the future? *

Yes

No, but I plan to implement dance medicine into my current/future clinic that I work at

Not sure yet

How did you hear about this program? *

Submit

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