1.
Name (First, Middle, Last) :
2.
Address :
3.
City :
4.
State :
ALABAMA
ALASKA
AMERICAN SAMOA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FEDERATED STATES OF MICRONESIA
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARSHALL ISLANDS
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
NORTHERN MARIANA ISLANDS
OHIO
OKLAHOMA
OREGON
PALAU
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
CANADA
MEXICO
CENTRAL AMERICA
SOUTH AMERICA
EUROPE
ASIA
AUSTRALIA
OTHER
5.
Zip :
6.
Primary Telephone (including area code):
( )
7.
Additional Telephone (including area code):
( )
8.
Primary E-Mail Address : (This e-mail should be available
for you to access now and during the summer months. All TAA
correspondence will be sent to this e-mail address.)
Re-enter Primary E-Mail Address :
9.
Secondary E-Mail Address :
10.
Name of school where you currently teach :
11.
School Telephone :
( )
12.
Name of Principal:
13.
Principal's E-Mail:
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 school:
Public
Private
16.
If you teach in a public school in Tennessee, please select your school system name from this pull-down list:
Select your school system
Alamo
Alcoa
Anderson County
Athens
Bedford County
Bells
Benton County
Bledsoe County
Blount County
Bradford
Bradley County
Bristol
Campbell County
Cannon County
Carroll County
Carter County
Cheatham County
Chester County
Claiborne County
Clay County
Cleveland
Clinton
Cocke County
Coffee County
Crockett County
Cumberland County
Davidson County
Dayton
Decatur County
Dekalb County
Dickson County
Dyer County
Dyersburg
Elizabethton
Etowah
Fayette County
Fayetteville
Fentress County
Franklin
Franklin County
Gibson County SP District
Giles County
Grainger County
Greene County
Greeneville
Grundy County
H Rock Bruceton
Hamblen County
Hamilton County
Hancock County
Hardeman County
Hardin County
Hawkins County
Haywood County
Henderson County
Henry County
Hickman County
Houston County
Humboldt
Humphreys County
Huntingdon
Jackson County
Jefferson County
Johnson City
Johnson County
Kingsport
Knox County
Lake County
Lauderdale County
Lawrence County
Lebanon
Lenoir City
Lewis County
Lexington
Lincoln County
Loudon County
Macon County
Madison County
Manchester
Marion County
Marshall County
Maryville
Maury County
McKenzie
McMinn County
McNairy County
Meigs County
Memphis
Milan
Monroe County
Montgomery County
Moore County
Morgan County
Murfreesboro
Newport
Oak Ridge
Obion County
Oneida
Overton County
Paris
Perry County
Pickett County
Polk County
Putnam County
Rhea County
Richard City
Roane County
Robertson County
Rogersville
Rutherford County
Scott County
Sequatchie County
Sevier County
Shelby County
Smith County
South Carroll
Stewart County
Sullivan County
Sumner County
Sweetwater
Tipton County
Trenton
Trousdale County
Tullahoma
Unicoi County
Union City
Union County
Van Buren County
Warren County
Washington County
Wayne County
Weakley County
West Carroll SP District
White County
Williamson County
Wilson County
Private SchoolPrivate School System
Not sure of my school system
My school system is not listed
17.
Choose Grade Level and Concentration Area in which you wish to participate at the Academy:
Elementary/Lower Middle
Music
Theatre
Visual Art
School Administration
Upper Middle/Secondary
Instrumental Music
Vocal Music
Theatre
Visual Art
School Administration
17A.
If you are an upper middle/secondary music instrumental applicant, please answer the following:
A. I teach:
Band
Orchestra
Band and Orchestra
B. I play the following instrument(s):
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 2010-2011:
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
Not Applicable
25.
Years you have attended the TAA in the past. (check all that apply):
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Prior to 2000
Never Attended
25A.
Select the most recent year that you attended the TN Arts Academy (select only one):
Never Attended
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Prior to 2000
25B.
Which initial means of communication prompted you to apply for the 2010 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)
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.
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
29.
Degrees earned (check all that apply):
Bachelors
Masters
Specialist in Education
Doctorate
Other (please specify)
30.
Years teaching experience:
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 2010-2011:
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 2010-2011
32.
**[K-8 Classroom Teachers only, please respond] Grade level you will likely teach 2010-2011:
K
1
2
3
4
5
6
7
8
I will not be teaching in 2010-2011
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 2010-2011 (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 2010-2011
Not applicable
34.
**[All Teachers, please respond] Please select the approximate number of classes of students per day you will teach in 2010-2011 (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 2010-2011
35.
**[All Teachers and Building Administrators, please respond] Approximate total number of students in your school for 2010-2011:
Less than 250
250-500
501-750
751-1000
1001-1500
1501-2000
2001-3000
3000+
I will not be teaching in 2010-2011
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%
16-20
71-80%
81-90%
91-100%
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%
16-20
71-80%
81-90%
91-100%
Additional Comments:
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