EmailMeForm
HeART with LINES Program Application
Name of School
*
Name of Contact person
*
First
Last
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Email
*
Phone
*
###
-
###
-
####
Residency Type
Dance integrated into the curriculum
Dance in the classroom
Proposed Start Date
*
MM
/
DD
/
YYYY
Proposed End Date
*
MM
/
DD
/
YYYY
Please provide a link to a district calendar and list additional dates classes will NOT be held (Holidays, field trip, etc.) Or, list all dates class will not be held.
*
First Choice for Class Day and Time
Time
Monday
Tuesday
Wednesday
Thursday
Friday
Second Choice Class Day and Time
Time
Monday
Tuesday
Wednesday
Thursday
Friday
What Grade are your Students?
*
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Have you Previously had a dance residency at your school?
*
Yes
No
If yes, please list the year, grade, classroom teacher, and the class type
How did you hear about HeART with LINES dance residency?
Are you interested in Community Performance Events?
Yes
No
Additional Comments
