TAI Teacher Participation Application Form Survey

Vision: To cultivate a Community of Support for Teaching Artists in Maryland.

Purpose: This application is for your teaching and TAI 21st Century Skills. (Beginning January 2011)

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1. Please answer the following:

	MM		DD		YYYY
Today's Date	Please answer the following: Today's Date Month	/	Day	/	Year

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2. Please answer the following contact information. Enter your Home address, email, home phone, and cell phone information.

Please answer the following contact information. Enter your Home address, email, home phone, and cell phone information. Name:
School:
Home Address:
Home Address 2:
City/Town:
State:
ZIP:
Country:
Email Address:
Home Phone Number:

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3. Enter the following Contact information regarding your school. Enter your name, your school's name, your school's address, the grade/subject you teach as well as your cell phone number.

Enter the following Contact information regarding your school. Enter your name, your school's name, your school's address, the grade/subject you teach as well as your cell phone number. Name:
School Name:
School Address:
School Address 2:
City/Town:
State:
ZIP:
School District:
Grade(s) You Teach:
Cell Phone Number:

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4. Please describe your class/classes with the following:

Grade Level
Subjects
Size of Class

Please describe your class/classes with the following: Grade Level Subjects Size of Class

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5. Have you completed the Maryland Artist/Teacher Institute (MATI)?

Have you completed the Maryland Artist/Teacher Institute (MATI)? Yes

If so, how many times have you attended MATI?

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6. Number of years as a teacher:

Number of years as a teacher:

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7. Have you hosted an artist-in-residence program in the past?

Have you hosted an artist-in-residence program in the past? Yes

If so, please describe (who/what):

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8. Number of Students per class

Number of Students per class

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9. School start and end times:

	MM		DD		YYYY
School Start	School start and end times: School Start Month	/	Day	/	Year
School End	School End Month	/	Day	/	Year

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10. Which art discipline interests you most?

Which art discipline interests you most? Dance

Drama

Music

Visual Art

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11. Would you be willing to drive to meetings outside of your school district?

Would you be willing to drive to meetings outside of your school district? Yes

12. Other information we should know about you or your school which will help us make our decision:

Other information we should know about you or your school which will help us make our decision:

TAI Teacher Participation Application Form
Exit this survey

1. Teaching Artist Institute

*
1. Please answer the following:

*
2. Please answer the following contact information. Enter your Home address, email, home phone, and cell phone information.

*
3. Enter the following Contact information regarding your school. Enter your name, your school's name, your school's address, the grade/subject you teach as well as your cell phone number.

*
4. Please describe your class/classes with the following:

Grade Level
Subjects
Size of Class

*
5. Have you completed the Maryland Artist/Teacher Institute (MATI)?

*
6. Number of years as a teacher:

*
7. Have you hosted an artist-in-residence program in the past?

*
8. Number of Students per class

*
9. School start and end times:

*
10. Which art discipline interests you most?

*
11. Would you be willing to drive to meetings outside of your school district?

12. Other information we should know about you or your school which will help us make our decision:

TAI Teacher Participation Application FormExit this survey

1. Teaching Artist Institute

*1. Please answer the following:

*2. Please answer the following contact information. Enter your Home address, email, home phone, and cell phone information.

*3. Enter the following Contact information regarding your school. Enter your name, your school's name, your school's address, the grade/subject you teach as well as your cell phone number.

*4. Please describe your class/classes with the following:Grade LevelSubjectsSize of Class

*5. Have you completed the Maryland Artist/Teacher Institute (MATI)?

*6. Number of years as a teacher:

*7. Have you hosted an artist-in-residence program in the past?

*8. Number of Students per class

*9. School start and end times:

*10. Which art discipline interests you most?

*11. Would you be willing to drive to meetings outside of your school district?

12. Other information we should know about you or your school which will help us make our decision:

TAI Teacher Participation Application Form
Exit this survey

*
1. Please answer the following:

*
2. Please answer the following contact information. Enter your Home address, email, home phone, and cell phone information.

*
3. Enter the following Contact information regarding your school. Enter your name, your school's name, your school's address, the grade/subject you teach as well as your cell phone number.

*
4. Please describe your class/classes with the following:

Grade Level
Subjects
Size of Class

*
5. Have you completed the Maryland Artist/Teacher Institute (MATI)?

*
6. Number of years as a teacher:

*
7. Have you hosted an artist-in-residence program in the past?

*
8. Number of Students per class

*
9. School start and end times:

*
10. Which art discipline interests you most?

*
11. Would you be willing to drive to meetings outside of your school district?