Arts in Residency Application
School or Organization
Date:
Mailing Address
City
State Zip
School/Site Number Email Address
Name of On-site Coordinator
On-site Coordinator Home Telephone
Name of Authorizing Agent
Number of Weeks Requested    
List two Artist choices in priority order
Choice 1 Choice 2
Indicate Preferred Residency Dates
Choice 1 Choice 2
Indicate grade levels and approximate number of students, teachers, parents, and staff who will participate in residency.
List any other special groups that will participate (gifted, challenged, special needs, etc.)
Goals you hope to achieve with this particular residency

Applications received before November 30, $750 per week
Applications received after November 30, $800 per week
Principal
Site Coordinator