Teacher Institute Summer 2012
French Impressionism and Post-Impressionism

Applications are due March 15, 2012. Only completed applications will be considered.

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 French Impressionism and Post-Impressionism will relate to your teaching.


6. In 50 words or less, state how you plan to share the 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, select the appropriate funding source below.

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 (no commas, dashes, or parentheses, for example, 5555555555):

13. School name:

14. School address:

15. City:

16. State:

17. Zip code:

18. School telephone (no commas, dashes, or parentheses, for example, 5555555555):

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. For which session are you applying? (If available for more than one session, please prioritize your choices.):

Session 1 (July 16–21, 2012): First    Second

Session 2 (July 30–August 4, 2012): First    Second

25. My geographical region is (choose one only; see map)

Image: Map of the United States

26. How did you hear about the Teacher Institute? (check all that apply)

Teacher Institute postcard
NGA Web site
NGA e-mail announcement
Colleague
Conference
Art Education: The Journal of the National Art Education Association
Other (describe):

Teammate Information (if applicable)

1. Name:

2. E-mail:

3. Subject(s) you teach:

4. Grade level(s) of students you teach:

5. Home address:

6. City:

7. State:

8. Zip code:

9. Home telephone (no commas, dashes, or parentheses, for example, 5555555555):

10. School name:

11. School telephone (no commas, dashes, or parentheses, for example, 5555555555):

12. Number of years teaching:

13. Are you a Teacher Institute alumnus/alumna?

Yes No

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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