Love, Move, Play™: Dance in Early Childhood – Winter 2024

Name: *

Professional Title: Dance Teaching Artist Classroom Teacher Credentialed Dance Educator Non-teaching Artist Administrator Student Other

Address:

City: *

State/Province: * 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 NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT Foreign

Zip/Postcode: *

Home Phone:

Mobile Phone:

Email: *

How did you hear about us?: Luna Website Friend Flyer Postcard send to you Email sent to you Child's school Community Calendar Display Ad Other

Demographic info for grant purposes: What are your teaching settings? Check all that apply.: studio public school private school charter school university/college community center ECE setting other N/A

Demographic info for grant purposes: If you teach in a public school, what district is it in? (type n/a if not applicable): *

Demographic info for grant purposes: What age(s) are your students?: 0-2 ECE 3-5 ECE 5-6 kindergarten 7-10 elementary 11-13 middle school 14-18 high school college/university adults seniors N/A

Demographic info for grant purposes: How many children do you anticipate teaching this academic year? (type n/a if not applicable): *

Demographic info for grant purposes: How many of these children have special needs? (type n/a if not applicable): *

Would you like to receive monthly Dance Educator Newsletters and updates from Luna?: * yes please no thanks