ArtReach Free Workshop Application "*" indicates required fields Date* MM slash DD slash YYYY Name of School* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Principal Name* First Last Email* Phone*Contact if other than Principal First Last Other contact phoneOther contact email School InformationGrade levels in school* Total number of students in school* Visual Art Instruction InformationDo you currently have a visual art program at your school?* Yes No What program?*Are you a Title I school?* Yes No Percent Title I eligible students* Do have a PTA or PTO that funds arts programming for your school?* Yes No Does your school or district have a Foundation that funds arts programming for your school?* Yes No Brief Explanation of NeedPlease describe why you believe your school qualifies for a free or low cost ArtReach program:*ArtReach Program LogisticsWould you like ArtReach workshops for more than one grade level?* Yes No The ArtReach Free Program provides up to four classrooms with ten workshops. Additional classrooms may be added at a discounted rate.What grade levels will we work with?* Total number of students in these grade levels?* Does your school have a multi-purpose room that could be used for ArtReach workshops?* Yes No ArtReach requests an empty classroom for workshops. Classes will rotate through the room. A sink is helpful, and allows us to include paint in your workshops.When would you like the ArtReach program to take place? (check all that apply)* August September October November December January February March April May June July CAPTCHA
