Teaching Artist Workshop Application

Instructions:

The questions in the application are designed to describe what you do, and to distinguish your work from other artists who apply. Please respond to all questions as they relate to you and your experience as a performing or visual artist.

Caution: Please use tab key or mouse click between questions. If the "enter" key is pressed, Windows IE will attempt to prematurely "submit" the application. If this should happen please click the "back" button to return to your application.

Please provide the following (*required)

First Name*

Last Name*

Address*

City*

State*

Zip*

Phone (day)*

Phone (cell)

Email*

Work Experience. Respond to questions about your work with students. Describe your experience offering school performances, demonstration lessons for students, school residencies, or other work. Answer all questions that apply to you.

1.	Have you worked with or performed for elementary students (Pre-Kindergarten through Grade 6)? If response is no, check the box and go to question 27

	Yes
	No (Skip to Q. 27)

Elementary School Performances (Pre-Kindergarten - Grade 6)

2.	Number of Years

3.	Most Recent Year

4.	Number of Sessions in Most Recent Year

5.	Please check the art form(s) or discipline(s) in which you usually work with young people.

	(Select all that apply.)
	Dance
	Music
	Theatre
	Visual Art

6.	Be more specific about what you do within the discipline(s).

7.	Do you make connections between the art form and the curriculum?

	Yes
	No

Elementary School Demonstrations or Lessons for Students (Pre-Kindergarten - Grade 6)

8.	Number of Years

9.	Most Recent Year

10.	Number of Sessions in Most Recent Year

11.	Please check the art form(s) or discipline(s) in which you usually work with young people.

	(Select all that apply.)
	Dance
	Music
	Theatre
	Visual Art

12.	Be more specific about what you do within the discipline(s).

13.	Do you make connections between the art form and the curriculum?

	Yes
	No

Elementary School Residencies (Pre-Kindergarten - Grade 6)

14.	Number of Years

15.	Most Recent Year

16.	Number of Sessions in Most Recent Year

17.	Please check the art form(s) or discipline(s) in which you usually work with young people.

	(Select all that apply.)
	Dance
	Music
	Theatre
	Visual Art

18.	Be more specific about what you do within the discipline(s).

19.	Do you make connections between the art form and the curriculum?

	Yes
	No

Elementary School (Pre-Kindergarten - Grade 6), Other type of work.

20.	Please describe "other".

21.	Number of Years

22.	Most Recent Year

23.	Number of Sessions in Most Recent Year

24.	Please check the art form(s) or discipline(s) in which you usually work with young people.

	(Select all that apply.)
	Dance
	Music
	Theatre
	Visual Art

25.	Be more specific about what you do within the discipline(s).

26.	Do you make connections between the art form and the curriculum?

	Yes
	No

Secondary School Performances (Grades 7-12)

27.	Have you worked with or performed for secondary students (Grades 7 - 12)? If response is no, check the box and go to question 53

	Yes
	No (Skip to Q. 53)

28.	Number of Years

29.	Most Recent Year

30.	Number of Sessions in Most Recent Year

31.	Please check the art form(s) or discipline(s) in which you usually work with young people.

	(Select all that apply.)
	Dance
	Music
	Theatre
	Visual Art

32.	Be more specific about what you do within the discipline(s).

33.	Do you make connections between the art form and the curriculum?

	Yes
	No

Secondary School Demonstrations or Lessons (Grades 7-12)

34.	Number of Years

35.	Most Recent Year

36.	Number of Sessions in Most Recent Year

37.	Please check the art form(s) or discipline(s) in which you usually work with young people.

	(Select all that apply.)
	Dance
	Music
	Theatre
	Visual Art

38.	Be more specific about what you do within the discipline(s).

39.	Do you make connections between the art form and the curriculum?

	Yes
	No

Secondary School Residencies (Grades 7-12)

40.	Number of Years

41.	Most Recent Year

42.	Number of Sessions in Most Recent Year

43.	Please check the art form(s) or discipline(s) in which you usually work with young people.

	(Select all that apply.)
	Dance
	Music
	Theatre
	Visual Art

44.	Be more specific about what you do within the discipline(s).

45.	Do you make connections between the art form and the curriculum?

	Yes
	No

Secondary School (Grades 7 - 12), Other type of work.

46.	Please describe "other".

47.	Number of Years

48.	Most Recent Year

49.	Number of Sessions in Most Recent Year

50.	Please check the art form(s) or discipline(s) in which you usually work with young people.

	(Select all that apply.)
	Dance
	Music
	Theatre
	Visual Art

51.	Be more specific about what you do within the discipline(s).

52.	Do you make connections between the art form and the curriculum?

	Yes
	No

Professional Development

Types of work include Professional Development Workshops, Courses, Professional Development as part of a residency, Professional Development Residencies and "Other". Respond only to those questions which are applicable to you.

53.	Have you ever provided professional development for teachers? If response is no, check the box and go to question 70

	Yes
	No (Skip to Q. 70)

Professional Development Workshop

54.	Number of Years

55.	Most Recent Year

56.	Number of Sessions in Most Recent Year

Course(s) Taught

57.	Number of Years

58.	Most Recent Year

59.	Number of Sessions in Most Recent Year

Professional Development as part of a residency

60.	Number of Years

61.	Most Recent Year

62.	Number of Sessions in Most Recent Year

Professional Development Residency

63.	Number of Years

64.	Most Recent Year

65.	Number of Sessions in Most Recent Year

Professional Development, Other

66.	Please describe "other".

67.	Number of Years

68.	Most Recent Year

69.	Number of Sessions in Most Recent Year

Organizations and Agencies

Please list your affiliations if applicable.

70.	Are you currently associated with an arts in education organization or program, an arts council, or arts agency?

	Yes
	No

Name of Organization/Agency and related Contact Information

71.	Name of first organization

72.	Name of contact person:

73.	Title of contact person:

74.

Phone:

75.

E-mail:

76.	Name of second organization (if applicable)

77.	Name of contact person:

78.	Title of contact person:

79.

Phone:

80.

E-mail:

81.	Name of third organization (if applicable)

82.	Name of contact person:

83.	Title of contact person:

84.

Phone:

85.

E-mail:

General Questions

Yes

86.	Are you a member of the Mississippi Alliance for Arts Education?

87.	Have you previously attended MAAE-sponsored events?

88.	Are you currently listed on the Mississippi Arts Commission's Artist Roster?

89.	Do you intend to apply to the Mississippi Arts Commission's Teaching Artist Roster?

90.	If your response to the above was yes, do you plan to apply March 1, 2010?

91.	If your response to the prior question was no, please indicate when you might.

	2011
	Never

92.	What are your current artistic/professional activities? (Limit, 150 words)

93.	What do you hope to gain by attending the workshop? (Limit, 300 words)

The following question is a precaution to ensure that the person responding hasn't inadvertently attempted to "submit" the application prematurely by using the "enter" key instead of "tab" or mouse click between questions.

94.	Are you ready to submit the application? If so, check "Yes", then click the "Submit" button below.

Yes

Thank you for your application.

Please consider becoming a member of the Mississippi Alliance for Arts Education so that you may add your voice
to members across the state who seek to increase access to arts education for all Mississippi students.

Surprising Solutions: Arts Education

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