BrainDance Submission Form

* = required field

First Name, Middle Initial, & Last Name *

Home Phone *

Email Address *

Project Title *

Please submit only one submission form per project. Please enter the names of any additional students here *

Enter your class name (example: Biology 1): *

Select project category *

Art
Academic
Mixed Media

Grade Level & School Name *

School Address *

School Main Office Phone *

Teacher’s Name *

Teacher’s Email *

Principal’s Name *

Check the appropriate box below *

I will submit my project files via e-mail.
I will mail or hand-deliver my project with this form.

File Upload *

BrainDance Resources

Mailing Address

Paula Rego, Family Resource Center
The Institute of Living, Carolina Cottage
200 Retreat Ave
Hartford, CT 06106
Contact Us

Phone: 860.545.7665
Email Paula Rego
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Institute of Living

200 Retreat Avenue, Hartford, CT 06106

Get Directions • Call: 860.545.7000 • Email Us

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