Sleeping Beauty Student Matinee PD Workshop Registration and Bus Funding Application The Sleeping Beauty Student Matinee PD Workshop Registration and Bus Funding Application FormPD Workshop: Friday, April 21, 2023, 9 a.m. - 12:30 p.m. PBT Studios, 2900 Liberty Ave., Pittsburgh, PA 15201 // Student Matinee: Fri., May 19, 2023, 12 p.m., Benedum Center for the Performing ArtsName First Last Title Subject (If applicable) Email PhoneSchool Name School Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County District Name of Educator attending PD Workshop (if different from above) First Last Email of Educator attending PD Workshop (if different from above) Total number attending the matinee, including students, teachers and chaperones. (Please note: this is NOT your ticket reservation! Please contact Jamie Adams at groupsales@pittsburghballet.org to reserve and purchase your tickets to the performance. Thanks!)Grade(s) of students attending the matinee. My school is applying for bus funding. Yes No Percentage of students participating in Free and Reduced Lunch program at my school (skip if not applying for bus funding).Please select the funding level you are applying for (skip if you're not applying for bus funding). $200.00 (41% and up) $175.00 (31-40%) $125.00 (26-30%) $100.00 (21-25%) My school is applying for reimbursement for a substitute to compensate for teacher attending the PD Workshop. (up to $100) Yes No If you are applying for sub reimbursement, please indicate your school's sub reimbursement rate. (subject to verification)Please enter any additional information you would like us to know.Signature required: I attest that the information provided above is correct based on the most recent information available and that my principal or administrator is aware of and approves of this application. My principal or administrator also approves of and supports my preparing my students to attend the student matinee as well as travel to the matinee itself. Please type applicant's name into field below to confirm the above. Δ
