Arts & Culture Teaching Artist and Program Survey

Teaching Artist Name *

First Name Last Name

Organization Name (if applicable)

Contact Name (if other than teaching artist)

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Website *

Facebook Handle

Instagram Handle

County in which you reside *

Artist Bio (please provide a summary of significant facts about your art career) *

Artist's Statement (please provide a brief description of your work that shapes the viewers' perspective when they are looking at your art or watching your performance) *

What program formats do you offer? *

On-Site Programs Off-Site Programs Artist Residency Private Lessons Summer Programs Virtual Programs

What type of arts & culture education programs do you offer? *

Visual Art Music Dance Theatre Historical/Cultural Folk Art Multidisciplinary Arts Language/Literacy

What ages/grades do you work with?

All Ages Elementary Middle School Highschool K-12 Adult Senior

Do you have a current background check?

Yes No I don't know

What schools or districts do you work with, or have you worked with in the past three years?

What programs do offer? *EACH PROGRAM LISTING MUST INCLUDE 1.) PROGRAM DESCRIPTION, 2.) PROGRAM LENGTH, 3.) AGE GROUP, 4.) PROGRAM PRICE, 5.) TRAVEL FEE, 6.) PARTICIPANT LIMIT

Please provide us with 1-2 testimonials. *Include the name of the person giving the testimonial and associated program.

Please upload 2-3 images of your work (.jpg or .pnc HiRes 1920px x 1280px) - *Name the file the title of the work pictured - e.g. PHOTOTITLE.jpg

Please provide a recent headshot or photo of yourself. (.jpg or .pnc HiRes 1920px x 1280px)