Caregiver Email address (please enter carefully so we can contact you!) *
Your answer
Caregiver Phone Number *
Your answer
Student Name *
Your answer
Do you receive governmental aid (i.e. Welfare, Medi-Cal, SSI, SSA, etc.). Yes or No is a fine answer, but please if yes, please be specific as to which program you are in. *
Your answer
How many people are living in your household? *
Your answer
What is your annual household income? *
Your answer
Are you in need of a full scholarship or a partial one? If partial, how much could you contribute? *
Your answer
Anything else we should know?
Your answer
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This form was created inside of Lineage Dance Company.