First Name*
Last Name*
E-Mail*
Phone Number*
Address
City
State
Zip
Previous Dance Education: (Please provide dates of education and former teacher/dance coach and studio name)
Previous Dance Instruction Experience, if applicable: (Please provide date of employment, studio name and description)
Dance Achievements, if applicable: (Please provide dance awards and titles earns and dates)
Classes or Clinics that you feel will benefit your ability as an instructor, if applicable:
Do you have any videos online of you dancing? If so, please enter the url location here:
How you heard about us:
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