ArtReach Free Workshop Application

Date*

Name of School*

Address*

Street Address City State ZIP Code

Principal Name*

First Last

Email*

Phone*

Contact if other than Principal

First Last

Other contact phone

Other contact email

School Information

Grade levels in school*

Total number of students in school*

Do you currently have a visual art program at your school?*

What program?*

Are you a Title I school?*

Percent Title I eligible students*

Do have a PTA or PTO that funds arts programming for your school?*

Does your school or district have a Foundation that funds arts programming for your school?*

Please briefly describe why you believe your school qualifies for a free or low cost ArtReach program:*

Would you like an ArtReach workshop for the entire school?*

What grades will we work with?*

Total number of students?*

Does your school have a multi-purpose room that could be used for ArtReach workshops?*

When would you like the ArtReach program to take place? (check all that apply)*

Year?*