1. Name:
2. E-mail:
3. Subject(s) you teach:
4. Grade level(s) of students you teach:
5. Individual or team statement of purpose. (In 250 words or less, state why you wish to attend this program and how 17th-century Dutch art will relate to your teaching.)
6. In 50 words or less, state how you plan to share the Teacher Institute experience with colleagues upon completion of the program and estimate the number of educators who will benefit. (Limited enrollment requires that each program participant commit to extending the program's impact through publication or instruction.)
7. If applying for a fellowship, please select the appropriate funding source below.
(select fellowship) Annetta J. and Robert M. Coffelt Sr. and Robert M. Coffelt Jr. Endowed Fellowship Sara Shallenberger Brown Fund
In 50 words or less, state how the fellowship would support your professional development goals and classroom instruction.
8. Home address:
9. City:
10. State:
11. Zip code:
12. Home telephone:
13. School name:
14. School address:
15. City:
16. State:
17. Zip code:
18. School telephone:
19. Number of years teaching:
20. Are you a Teacher Institute alumnus/alumna?
Yes No
21. If yes, which year(s)?
22. Who is your congressional representative?
23. What is your congressional district number?
24. I wish to apply for the following session (if available for more than one session, please prioritize your choices):
Session 2 (July 28–August 2, 2008): First Second
25. My geographical region is (choose one only; see map)
26. How did you hear about the Teacher Institute? (check all that apply)
Teacher Institute postcard NGA Web site NGA Teacher and School Programs brochure Colleague Conference Art Education: The Journal of the National Art Education Association Other (please describe):
5. Home address:
6. City:
7. State:
8. Zip code:
9. Home telephone:
10. School name:
11. School telephone:
12. Number of years teaching:
13. Are you a Teacher Institute alumnus/alumna?
14. If yes, which year(s)?
15. Who is your congressional representative?
16. What is your congressional district number?
Click on "Submit" below to send your completed application to the National Gallery of Art Teacher Institute. Thank You.
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