Student Rep Application

For students wishing to apply for the Student Rep Program from X-POLE

For students wishing to apply for the Student Rep Program from X-POLE

Phone

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Instagram

How long have you been pole dancing?(Required)

Less than 1 year

1-2 years

3-4 years

5-6 years

More than six years

Tell us about yourself. What makes you, YOU?(Required)

What are your career goals?(Required)

What do you like to do for fun? Describe a day in the life of _______ (you).(Required)

In what ways will becoming an X-POLE Student Rep help you?(Required)

How do you plan to make your adventure as an X-POLE Student Rep a fun & successful one?(Required)

How do you plan to promote the X-POLE brand?(Required)

What is your personal experience with X-POLE or Pole Fitness in general?(Required)

Include any other fun facts about you(Required)

Upload any images to support your application

Max. file size: 50 MB.