Rhythm Works Integrative Dance/Wingman Scholarship Application

* 1. What is your full name?

* 2. What is your phone number?

* 3. What is your email address?

* 4. What is your address?

Street Address

City

State/Province

Country

Zip Code

* 5. What is your profession?

Dance Teacher

Studio Owner

Dance Department Director

Occupational Therapist

Physical Therapist

ABA Therapist

Speech and Language Pathologist

Developmental Play Specialist

Physical Education Teacher

Special Education Teacher

Other (please specify)

* 6. How many years have you been active in your profession, and what are your specialties?

* 7. Do you have any experience working with people with special needs or individual learning differences? If so, please let us know about it.

* 8. If chosen to receive this scholarship, how to do intend to put the Rhythm Works Integrative Dance certification to use?

* 9. Tell us about what makes you unique! What types of things do you love doing...what are your interests...how do you stand out from the crowd...have you received any awards or accolades...and anything else you'd like us to know about you!

* 10. What do you hope to learn from the Rhythm Works Integrative Dance Instructor Certification Workshop?