Teaching Artist Workshop Application

Please provide the following information and respond to all questions that apply to your work as a performing or visual artist. For most answers, check the boxes most applicable to you or fill in the blanks.

Please provide the following (*required)

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Phone*

Cell phone

Email*

1.	Please choose preferred workshop. (*Note that individuals who have taken Level I are eligible to apply for the Level II workshop.)

	August 31 - September 1, 2010 - Level I Workshop, Mississippi Department of Education, Jackson (Deadline: August 25, 2010)
	October 11 - 12, 2010 - Level I Workshop, Lynn Meadows Discovery Center, Gulfport (Deadline: October 1. 2010)
	November 8 - 9, 2010 - Level II Workshop*, Lauren Rogers Museum, Laurel (Deadline October 21, 2010)

2.	Check your Arts Discipline or Art Form

	Dance
	Music
	Theatre
	Visual Art
	Multi-disciplinary

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 or teacher?

	(Select all that apply.)
	School performances
	Demonstration lessons for students and their teachers
	Professional development for teachers
	Other:

6.	Work in the art form: Describe your work with an example from an area checked in previous section. 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?

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

	Yes
	No

9.	Have you previously attended MAAE-sponsored events?

	Yes
	No

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

	Yes
	No

11.	Why do you want to work as a teaching artist with students and teachers in schools? (Limit 300 words)

12.	What do you hope to gain by attending the Teaching Artist Workshop? (Limit 300 words)

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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