Registration

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Please read the information below in order to be considered for the Male Scholarship Program at Central Pennsylvania Youth Ballet.

RETURNING applicants must login to their Family Portal using the red link above. Please contact CPYB at 717.245.1190 if you need assistance with your username and password. Again, one application per student only.

Complete and submit the following application in its entirety. ALL FIELDS ARE REQUIRED.
If you are under the age of 18, enter parent/guardian name, phone, e-mail, and mailing address in the contact field. Students must enter all required information in the "add student" option.

Questions? Email us at mensprogram@cpyb.org.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact (Include name, address, phone number, e-mail)*

Students entered below will be added to your family's account

Questions/Options:


How did you hear about the Male Scholarship Program?*
Age*
Height*
Weight*
Total years of ballet training?*
List previous training (include school(s) name, years attended, classes per week attended, city, state, school's e-mail/phone). Please use "Additional Information" below if needed.*
If you have studied previously at CPYB, please enter the program(s) (Academic Year, 5-Week Summer Ballet Program, August Course), year(s) attended and level(s) you were in.*
Reference #1: Personal reference. Please list the name, organization, phone, e-mail, and relationship.*
Reference #2: Dance Reference. This should be an instructor or director of your school. Please list the name, organization, phone, e-mail, and relationship.*

Additional Information:

VIDEO SUBMISSION

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APPLICATION SUBMISSION

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NO FEE

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Enter your Full Name: