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Artist Registration

* = (required fields)
First Name*:
Middle Name:
Last Name*:
Address*:
Address 2:
City*:
State*:
Zip*:
Primary Phone*:() -
Secondary Phone:() -
Fax:() -
Email*:
Website:http://



Are you a certified arts teacher? Yes No

In which state(s) and which discipline?


Add Certifications:
Certification:
Discipline:
State(s):
(For multiple selections, PC - hold down key; MAC - hold down key)
  

Do you teach arts integration? Yes No



If you are an individual without your own facility, please provide a brief biography below:


If you are a facility offering arts education programming, please provide your organizations mission statement, and a brief description of your arts education programming below:


Submit details of teaching licenses and certifications here:
Organization:
Years of Experience:
Are you a staff member of and applying for a facility that offers arts education programming? Yes No
Title:


Are your programs aligned with Floridas Sunshine State Standards? Yes No
Floridas Sunshine State Standards
If not, are you able to attend a workshop/seminar to learn? Yes No
Would you be interested in attending Broward County Public Schools workshops? Yes No


Have you attended any Kennedy Center workshops? Yes No

Add Workshops:
Workshop:
Title:
Location:
Date: Click Here to select a date
  
Would you like to attend a Kennedy Center workshop/seminar? Yes No


Desired Audience
School Work
Community Work
After Care Programs




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