Community Outreach Scholarship Application

Please submit this form and one reference letter by June 30, 2026.

Name: *


First	Last

Address: *

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip Code

Are you a current member of Dance Alliance?: *

Yes

What county do you live in? *

Birth Date: *

Home Phone:

-
Area Code	Phone Number

Cell Phone:

-
Area Code	Phone Number

E-mail: *

School Currently Attending (Academic) and grade or year and/or where you are working. *

Dance Experience if any

Please provide one reference and their telephone numbers (Dance teacher, academic teacher, employees, coach, etc.): *

Plans for study at: *

Contact Person’s Name: *


First	Last

Email or Web Site: *

School/program/workshop location: *

CityState / Province / Region

Contact Person's Phone: *

-
Area Code	Phone Number

Dates of Program: *

Type of classes offered and by whom: *

Total Cost *

ESSAY: In our own words, please tell us about yourself and how this scholarship will help you personally. How will this dance experience enrich your life and that of your community?

If desired, upload a file to tell us more.