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2020-2022 Male Scholarship Program Application
RETURNING applicant? Login to your Family Portal using the red link above. Contact CPYB at 717.601.2840 if you need assistance with your username and password.
Deadlines for application submission (including video):
June 8, 2020 (age 14-16) and July 20, 2020 (age 17-19)
(STEP 1) Complete and submit the following application in its entirety. One application per student. Applicants under the age of 18, must enter parent/guardian name, phone, e-mail, and mailing address in the contact field.
(STEP 2) Submit your audition video by the appropriate deadline (above). Requirements available online at cpyb.org/school/mens-program/male-scholarship-program
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Adult Student
Dickinson Student
Family approved contact
Father
Grandparent
Guardian
Host Family
Male Scholarship Program Applicant
Mother
Parent
RA for Summer Program
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact (Include name, address, phone number, e-mail)
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Academic School District:
*
Physical Limitations:
Allergies (If none, enter N/A):
*
Medications (Leave blank if NONE):
Date of Most Recent Physical:
*
Previous Ballet Training?:
*
Previous Ballet Training cont.:
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Academic School District:
*
Physical Limitations:
Allergies (If none, enter N/A):
*
Medications (Leave blank if NONE):
Date of Most Recent Physical:
*
Previous Ballet Training?:
*
Previous Ballet Training cont.:
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Academic School District:
*
Physical Limitations:
Allergies (If none, enter N/A):
*
Medications (Leave blank if NONE):
Date of Most Recent Physical:
*
Previous Ballet Training?:
*
Previous Ballet Training cont.:
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Academic School District:
*
Physical Limitations:
Allergies (If none, enter N/A):
*
Medications (Leave blank if NONE):
Date of Most Recent Physical:
*
Previous Ballet Training?:
*
Previous Ballet Training cont.:
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Academic School District:
*
Physical Limitations:
Allergies (If none, enter N/A):
*
Medications (Leave blank if NONE):
Date of Most Recent Physical:
*
Previous Ballet Training?:
*
Previous Ballet Training cont.:
Questions/Options:
Age
*
Height
*
Name of current ballet school. Include city and state.
*
Number of BALLET classes per week (do not include other forms of dance)
*
Total years of BALLET training?
*
Is the applicant currently registered to attend the 2020 5-Week Summer Ballet Program or 2020 August Course program?
*
Yes
No
Has the applicant attended a CPYB program in previous years?
*
Yes
No
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.
*
How did you hear about the Male Scholarship Program?
*
Additional Information:
VIDEO SUBMISSION
(Show-Hide Details)
I understand that I must submit my audition video by the stated deadlines. Failure to do so will result in my application not being considered. Requirements available online at cpyb.org/school/mens-program/male-scholarship-program.
I've read the above and agree.
NO FEE
(Show-Hide Details)
I understand that there is no fee to apply for the Male Scholarship Program.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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