Please use appropriate capitalization on all answers throughout this application.
1. Name (First, Middle, Last) :
2. Address :
3. City :
4. State :
5. Zip :
6. Cell Phone (including area code) (List the best number for TAA to reach you):
()
7. Home Telephone or Additional Telephone (including area code):
()
8. Primary E-Mail Address : ( This e-mail must be available for you to access both now and during the summer months and must include the ability to accept attachments. All TAA correspondence will be sent to this e-mail address. Please be certain that this email address is correct and accessible to you at all times.)
  Re-enter Primary E-Mail Address :
9. Secondary E-Mail Address :
10. Name of school where you currently teach (If you work in the district office, please list the name of the district):
11. School Telephone :
()
12. Name of Principal (If you work in the district office, please list the name of the superintendent):
13. Principal's E-Mail (If you work in the district office, please list the E-Mail of the superintendent):
14. The school system where I teach is located in :
East Tennessee
Middle Tennessee
West Tennessee
Not in Tennessee (enter city and state where you teach)
     
I Am Not Currently Teaching
15. Type of K-12 school or school system:
Public Private Charter ASD Other
15A. If K-12 teacher and/or administrator is NOT your current primary occupation, please select the appropriate category which most closely matches your current status:
University Faculty
Pre-Service University Student
Teaching Artist or Private Lessons Instructor
Retired Teacher
Other
16. If you teach in a public school in Tennessee, please select your school system name from this pull-down list:
17. Choose Grade Level and Concentration Area in which you wish to participate at the Academy:
Elementary/Lower Middle
   Music
   Theatre/Cross Curriculum Arts Integration, Drama & Movement
   Visual Art
   Trio Track (Multidisciplinary Arts Track with one class daily in music, theatre, and visual art)
Upper Middle/Secondary
   Instrumental Music
   Vocal Music
   Theatre
   Visual Art
   Trio Track (Multidisciplinary Arts Track with one class daily in music, theatre, and visual art)
Arts Leadership, Administration and Assessment
   School Administrator
   District Supervisor
   Arts Teacher (NOTE: only check this box if you are registering in the Arts Leadership, Administration and Assessment area)
17A. If you are an upper middle/secondary instrumental music applicant, please answer the following:
A. I teach:
   Band
   Orchestra
   Band and Orchestra
B. I play the following instrument(s):
     
17B. Is the current grade level and concentration area that you indicated on this application (#17) different than your current teaching assignment?
Yes No
18. What is your teaching/supervisory status in your school:
Full time Part time
19. Grade levels you teach/supervise this year: (check all that apply):
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
20. Primary teaching area:
Specialist in Music, Theatre or Visual Art
Teacher (in area other than art, music, theatre)
Administrator/Supervisor
Other (please specify)
       
21. Specific teaching assignment (check all that apply):
Principal
Assistant Principal
Fine Arts Coordinator
Supervisor
Full Time Elementary Self-Contained Classroom Teacher
Music Teacher
Theatre Teacher
Speech Teacher
Theatre and Speech Teacher
Visual Art Teacher
Librarian
Special Education/Gifted Teacher
English/Language Arts Teacher
Other (please specify)
       
22. Please choose from the following to indicate your anticipated teaching assignment for school year 2018-2019:

I expect my assignment to be the same as this year
Principal
Assistant Principal
Fine Arts Coordinator
Supervisor
Full Time Elementary Self-Contained Classroom Teacher
Music Teacher
Theatre Teacher
Speech Teacher
Theatre and Speech Teacher
Visual Art Teacher
Librarian
Special Education/Gifted Teacher
English/Language Arts Teacher
Other (please specify)
       
23. Have you ever attended TAA previously in any area: 
Yes No
24. If you have attended TAA previously, in what area(s) did you participate? (check all that apply):
Music
Theatre
Visual Art
School Administration/Arts Administration/Assessment/Arts Leadership
Trio Track
Not Applicable
25. Years you have attended the TAA in the past. (check all that apply):
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
Prior to 2001
Never Attended
25A. Select the most recent year that you attended the TN Arts Academy (select only one):
Never Attended
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
Prior to 2001
25B. Which initial means of communication prompted you to apply for the 2018 Tennessee Arts Academy?
Postcard or flyer mailed to me from the TAA office
E-Mail sent to me from the TAA office
I visited the TAA WEB site and decided to apply
I visited a social networking site (Facebook, Twitter, etc.) and decided to apply
I read about TAA in an organizational newsletter
A friend and/or colleague told me about TAA
My school (or school system) provided teachers with information about TAA
Other (please specify)
     
25C. Will you need on campus housing while attending the Tennessee Arts Academy?
Yes No Not Sure Yet
26. TN Licenses/Areas of Endorsement that you presently hold (check all that apply):
Music (vocal/general), K-12
Music (instrumental/general), K-12
Visual Art, K-12
Theatre, K-12
Speech
Elementary Classroom
Special Education
Administration and Supervision
Physical Education
English
Early Childhood
Guidance
Library Science
I do not have a teaching license
Other (please specify)
     
  The following series of questions help us gather statistical data requested by the Tennessee Department of Education from all participants. Please note that some questions ask you to project teaching assignment information for the 2018-2019 school year, the school year following the 2018 summer Arts Academy session.
27. Gender:
Male Female
28. Ethnicity/Race:
Decline to answer
American Indian or Alaskan Native
Asian or Pacific Islander
Black, not of Hispanic origin
Hispanic
White, not of Hispanic origin
Other
29. Degrees earned (check all that apply):
Bachelors
Masters
Specialist in Education
Doctorate
Other (please specify)
     
30. Years teaching experience (as of the end of this current school year):
0
1
2
3
4
5
6-10
11-15
16-20
21-25
26-30
31-35
36-40
41-45
45+
31. Approximate number of students you will teach/serve/supervise in 2018-2019:
1-30
31-50
51-100
101-200
201-300
301-400
401-500
501-750
751-1000
1001-2000
2001-5000
5001-10,000
10,001-20,000
20,000+
I will not be teaching in 2018-2019
32. **[K-8 Classroom Teachers only, please respond] Grade level you will likely teach in 2018-2019:
K
1
2
3
4
5
6
7
8
I will not be teaching in 2018-2019
Not applicable
33. **[Arts Specialists (Music Teacher, Theatre/Speech Teacher, and Visual Arts Teacher) and Administrators only, please respond] Grade levels you will likely teach, serve or supervise in 2018-2019 (choose grouping that most nearly matches your anticipated assignment):
Pre-K-2
K-5
K-8
5-8
9-12
K-12
I will not be teaching in 2018-2019
Not applicable
34. **[All Teachers, please respond] Please select the approximate number of classes of students per day you will teach in 2018-2019 (Classroom teachers in a self-contained classroom should select "1"):
1
2-3
4-5
6-7
8-9
10-11
12-13
Not applicable
I will not be teaching in 2018-2019
35. **[All Teachers and Building Administrators, please respond] Approximate total number of students in your school for 2018-2019:
Less than 250
250-500
501-750
751-1000
1001-1500
1501-2000
2001-3000
3000+
I will not be teaching in 2018-2019
36. Approximate percentage of minority students in your school (or in your system if you are a system-wide administrator):
0-10%
11-20%
21-30%
31-40%
41-50%
51-60%
61-70%
71-80%
81-90%
91-100%
  Please provide TAA with the following additional information:
37. Approximate percentage of students on free or reduced lunch in your school (or in your system if you are a system-wide administrator):
0-10%
11-20%
21-30%
31-40%
41-50%
51-60%
61-70%
71-80%
81-90%
91-100%
37A. The Tennessee Arts Academy Foundation has established a scholarship fund that gives preference to those participants who meet the following criteria:
  • are first-time Academy attendees;
  • are financially unable to cover the cost of Academy tuition;
  • teach in a Tennessee school or school system that does not offer any financial support to its staff for professional development;
  • have no local support groups that can offer financial assistance (i.e. PTA, booster club, local business or service organization, etc.);
  • would submit to TAA a scholarship application and essay describing why financial assistance is needed.
  • Considering these criteria, would you want us to send you a scholarship application?
    Yes (I meet ALL of the above criteria)
    No
    Not Sure
    37B. Your FIRST NAME ONLY as you would like to see it on your nametag:
    37C. Your LAST NAME ONLY as you would like to see it on your nametag:
    37D. In this space type BOTH your FIRST AND LAST NAME (as you have indicated in 37B and 37C above) as you would like to see it on your nametag:
    37E. Your Name As You Would Like To See It Printed On Your TAA State Department of Education Formal Re-Certification Certificate:
    37F. T-SHIRT SIZE:
    S
    M
    L
    XL
    2X
    3X
    37G. Medical Needs:
    I have no medical conditions or physical limitations that will affect my participation.
    I DO have a medical condition or physical limitations that will affect my participation (If you check this answer, please complete 37H and/or 37I).
    37H. The following medical condition/s will affect my Academy participation:


    37I. The following physical limitation/s will affect my Academy participation:


    37J. Please select one of the three meal options below for the two served meals provided during the Academy:
    No Restrictions (knowing that the catered meals will NOT include pork or shellfish)
    Vegetarian
    Simple (dairy free; nut free; gluten free; egg free; soy free)
    37K. Do you have a severe, specific food allergy that would not be accommodated in any choice above?
    Yes No
    If yes, please describe:

    Additional Comments You Wish To Provide To The TAA Staff Regarding Your Application:



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