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Applicant Name*

Present College/University, Institutional Affiliation, or Courses Successfully Completed *

Area of Study, Dance Experience, Cheer Experience*

Certificate, Degree, or Experience *

Select an option

(If Applicable) Date of Dance Certification or Degree (will be granted or granted) Day/Month/Year

Briefly explain why LIOPA should consider/hire you as a competition cheer instructor, dance instructor, assistant instructor, or volunteer?**

Position Interest*

Select an option
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