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Maryland Artist/ Teacher Institute - Arts Education in Maryland ...

Maryland Artist/ Teacher Institute - Arts Education in Maryland ...

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<strong>Maryland</strong> <strong>Artist</strong>/<strong>Teacher</strong> <strong>Institute</strong>Mak<strong>in</strong>g ConnectionsNEW THIS YEAR-ELECTRONIC APPLICATION!http://aems-edu.org/PDFs/MATI_2012.pdfApplication “B” for Individuals S U M M E R 2 0 1 2DEADLINE: APRIL 20, 2012 – emailed, postmarked or hand-delivered by 5 p.m.Date __________________This application is for my admission as a school team member or as an <strong>in</strong>dependent <strong>in</strong>dividual to the 2012 <strong>Maryland</strong> <strong>Artist</strong>/<strong>Teacher</strong> <strong>Institute</strong> atthe University of <strong>Maryland</strong> University College. My registration fee is (a) covered by my team or (b) covered by a check <strong>in</strong> the amount of $200,made out to <strong>Arts</strong> <strong>Education</strong> <strong>in</strong> <strong>Maryland</strong> Schools Alliance, is enclosed or mailed separately if us<strong>in</strong>g electronic application. I understand thatfailure to register <strong>in</strong> person at the University of <strong>Maryland</strong> University College at the designated time on registration day or to complete all requirementsof the summer session will result <strong>in</strong> forfeiture of this refundable registration fee. Deadl<strong>in</strong>e: April 20, 2012 – postmarked or hand-deliveredby 5 p.m.PLEASE TYPE.NameTitle/positionHome addressCity, State, ZipHome PhoneHome EmailCell PhoneContact <strong>in</strong> caseof emergencyNamePhoneSocial Security Number (required for those desir<strong>in</strong>g credit)Room accommodations will be addressed <strong>in</strong> a subsequent mail<strong>in</strong>g.School nameSchool systemSchool addressCity, State, ZipSchool PhoneSchool EmailPlease specify all special dietary requirementsBACKGROUND INFORMATION:<strong>Education</strong> _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________Experience _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Why I wish to attend the <strong>Institute</strong> ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I am especially <strong>in</strong>terested <strong>in</strong>: Dance Music Theatre Visual Art Creative Writ<strong>in</strong>gI hereby give permission for the use of my photograph taken dur<strong>in</strong>g the <strong>Maryland</strong> <strong>Artist</strong>/<strong>Teacher</strong> <strong>Institute</strong> 2012. It is understood that any photographstaken will be used by the <strong>Maryland</strong> State Department of <strong>Education</strong> solely for the promotion of the <strong>Institute</strong>. (If you choose to not givepermission, please check here: ____ )Signed ______________________________________________________ Date ________________Send this application with a check <strong>in</strong> theamount of $500 made payable to “<strong>Arts</strong><strong>Education</strong> <strong>in</strong> <strong>Maryland</strong> Schools Alliance.”NEW THIS YEAR: Electronic Applicationhttp://aems-edu.org/PDFs/MATI_2012.pdfSend check separately.Return to:Shelley S. Johnson, F<strong>in</strong>e <strong>Arts</strong> SpecialistDivision of Instruction<strong>Maryland</strong> State Department of <strong>Education</strong>200 W. Baltimore StreetBaltimore, MD 21201-2595Sjohnson1@msde.state.md.usMake checks payable to “<strong>Arts</strong> <strong>Education</strong> <strong>in</strong> <strong>Maryland</strong> Schools Alliance.”<strong>Maryland</strong><strong>Artist</strong>/<strong>Teacher</strong><strong>Institute</strong>

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