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Teaching Artist Roster Application Form
Date
Submitted By
Artist / Group Name*
Legal Name (if Different)
Mailing Address 1*
Mailing Address 2
City/Town*
State
Vermont
County
Addison
Bennington
Caledonia
Chittenden
Essex
Franklin
Grand Isle
Lamoille
Orange
Orleans
Rutland
Washington
Windham
Windsor
Zip Code
Email*
Telephone Number*
Telephone type*
Cell
Home
Work
Other
Do you have a website?
Yes
No
Website URL
Do you have an Arts Directory listing? (Required for this application)
Yes
No
Arts Directory URL*
Artistic Discipline*
01 Dance
02 Music
03 Opera/music theatre
04 Theatre
05 Visual Arts
06 Design Arts
07 Crafts
08 Photography
09 Media Arts
10 Literature
11 Interdisciplinary
12 Folklife/Traditional Arts
13 Humanities
Sub-Discipline
Cultural Diversity Data
No Single Group
Asian
Black/African American
Hispanic/Latino
American Indian/Alaska Native
Native Hawaiian/Pacific Islander
White
I am experienced teaching my art form to the following populations: (check all that apply)*
Preschool/Early Ed
Primary K-6
Intermediate 7-8
Secondary 9-12
General/Mixed
Seniors
Disabilities
Youth At Risk
I am experienced teaching my art form in the following settings: (check all that apply)*
Early Education Programs
K-12 In-School Settings
Out of School Time (OST) Programs
Community Arts Organizations
Social Service Programs
Health Care Facilities
Special Needs Programs
Correctional Facilities
Availability During the Year (please specify if there are time you are not available)
Distance Willing to Travel (ie, Statewide, 50 mile radius, 2 hours)
Rates
Performance
Workshop
Schools (Single Day & Week Long)
Willing to Block Book?
Yes
No
Professional Reference 1
Affiliation (Reference 1)
Phone Number (Reference 1)
Professional Reference 2
Affiliation (Reference 2)
Phone Number (Reference 2)
Resume 1: Artistic and/or Teaching*
File Size:
5000KB Maximum
File Types:
.doc .pdf .txt
Resume 2 (if needed)
File Size:
5000KB Maximum
File Types:
.doc .pdf .txt
Promotional Photo or Image
File Size:
5000KB Maximum
File Types:
.jpg .jpeg .gif .bmp
Teaching Artist Statement (500 Words Maximum)*
By checking this box, I certify that I have never been convicted of a felony.
By checking this box, I assert that I have read and understand all of the roster guidelines, am generally available between March 15-31 for an interview, and have submitted an application that is true to the best of my knowledge.
Enter the code shown above
Submit
* Required
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