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* 1. Name:

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* 2. Email:

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* 3. School District:

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* 4. Position:

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* 5. School:

Professional Participation

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* 6. How many students are enrolled in your school?

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* 7. How many faculty members are employed in your school?

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* 8. What grade levels do you service?

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* 9. Which of the following arts disciplines/curriculum does your school offer? Please check all that apply.

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* 10. How many part-time arts specialists do you have on staff in the following disciplines? Enter 0 for none.

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* 11. How many full-time arts specialists do you have on staff in the following disciplines? Enter 0 for none.

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* 12. Is there a designated classroom space in your building for faculty to teach the following subjects?

  Yes No Shared Not applicable
Dance / Physical Education
Film Production
Music
Theatre
Visual Art

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* 13. What is your school's total annual arts budget, including materials, supplies, equipment, field trips, performances, and exhibits?

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* 14. Please select one of the following qualifying statements that best describes the arts-in-education budget in your school over the past five years.

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* 15. Do any of your arts teachers collaborate with faculty to write curriculum across subject areas?

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* 16. Studies have shown that integrating the arts across the curriculum helps students learn and gives meaning to other subject areas. Are you interested in offering your faculty professional development courses on arts integration?

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* 17. How many cultural field trips does your school budget for annually?

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* 18. Does your PTA/PTO support cultural programs in your school?

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* 19. Does your school present exhibits that are open to the community?

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* 20. Does your school produce dance, musical, and/or theatre performances that are open to the community?

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* 21. In the past five years, how often have your students been engaged in a community arts project or worked with a professional artist-in-residence in your school?

Personal Participation

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* 22. In the past year, have you personally attended any of the following cultural events outside of your school? Please check all that apply.

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* 23. Do you believe that arts education is essential to learning in other subject areas?

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* 24. If you would like to receive the ARTix Passport, please enter your name and mailing address.

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