Ballet Hispánico Community Arts Partnerships General Inquiry Form

Primary Contact First Name *

Last Name *

Group/Organization (if applicable) *

Job Title/Position

E-mail Address *

Phone Number *

Website

Street Address (Organization) *

City *

State *

Zip Code *

Council Member District: *

School District: *

Borough: *

Which of our Community Programs are you interested? (Check ALL that apply) *

Which of the following dance forms are you interested? (Check ALL that apply) *

Potential Starting Date: * +

Preferred Day(s) of the Week *

Preferred Time(s) of the Day *

Name of supporting teacher if applicable:

How many number of sessions (for residencies, master classes, workshops)? *

How many people/students would participate in the program (by estimate)? *

Grade/Year Level of Participants *

Where would the program take place? *

Please share any additional inquiries:

How did you hear about Ballet Hispánico's Community Programs? (Check ALL that apply) *

Flamenco	Latin Social Dances (Salsa, Bachata, Merengue)
Latin American Folk Dances	Afro-Caribbean Dance Forms
Other Other