Artist as Teacher 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 / Province*

Zip Code*

Phone (day)

Phone (evening)

Artist as Teacher Workshops (Please select one)

1.	Workshops:

	1) October 18-19, 2007 - Henry Jacobs Camp, Utica, MS. Application deadline: September 14, 2007
	2) November 12-13, 2007 - Delta Blues Museum, Clarksdale, MS. Application deadline: October 15, 2007
	3) February 21-22, 2008 - Henry Jacobs Camp, Utica, MS. Application deadline: January 25, 2008
	4) July 21-22, 2008 - University of Mississippi, Oxford, MS. Application deadline: June 20, 2008
	5) October 7-8, 2008 - Walter Anderson Museum, Ocean Springs, MS. Application deadline: September 12, 2008

General Information

2.	Arts Discipline or Art Form:

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

3.	Age Groups/Audiences: With whom have you worked in the last three years?

	(Select all that apply.)
	Pre-school age children
	Children 5-10
	Youth 11-18
	Adults

4.	Work Settings: In what settings have you worked? or Who has sponsored your work in the last three years?

	(Select all that apply.)
	Schools
	After-school programs
	Youth-based programs
	Libraries
	Arts organizations
	Community cultural organizations
	Healthcare facilities
	Adolescent offender programs
	Other:

5.	Work Description: What do you typically do in your role as a performer and/or teaching artist?

	(Select all that apply.)
	School performances
	Demonstration lessons for students
	School residencies
	Model lessons for teachers
	Other:

Work in the art form:

6.	Describe your work with an example from an area checked in question #5. Be specific about what you do within the art form. (Limit, 50 words)

7.	How many years have you practiced your art form or worked in the arts discipline?

Connecting the arts to school subjects:

8.	Do you make connections between your art form and the broader curriculum?

	Yes
	No

9.	If you responded yes to the above, with which core subject(s) do you typically make connections?

	(Select all that apply.)
	Reading/Language Arts
	Social Studies (History/Geography)
	Science
	Math
	Foreign Language
	Dance
	Music
	Theatre
	Visual Art

Work with teachers:

10.	Have you conducted professional development workshops for teachers?

	Yes
	No

11.	In you responded yes, please describe a professional development workshop you have conducted. Be specific about the topic, the number of hours of training, and the goals of the workshop. (Limit, 50 words)

12.	When did the workshop take place (month and year)?

Professional organization affiliations, if applicable.

13.	Are you currently associated with an arts in education organization or program, an arts council or arts agency? If your answer is yes, please list your affiliations below,

	Yes
	No

14.	Name of first organization

15.	Name of contact person:

16.	Title of contact person:

17.

Phone:

18.

E-mail:

19.	Name of second organization (if applicable)

20.	Name of contact person:

21.	Title of contact person:

22.

Phone:

23.

E-mail:

24.	Name of third organization (if applicable)

25.	Name of contact person:

26.	Title of contact person:

27.

Phone:

28.

E-mail:

General Questions

Yes

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

30.	Have you previously attended MAAE-sponsored events?

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

32.	Do you intend to apply to the MAC Arts in Education Roster?

33.	If your response to the above was yes, do you plan to apply March 1, 2008?

34.	If your response was "no" to question 33, please indicate when you might apply:

	2009
	Never

In your own words:

35.	Briefly describe your current artistic/professional activities. (Limit, 150 words)

36.	What do you hope to gain by attending the "Artist as Teacher" 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.

37.	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

Created with SurveyGold survey software - �2004 Golden Hills Software, Inc. - http://surveygold.com