SCHOOL TEACHING ARTIST IN RESIDENCE (STAIR) Application

Date of Application

School Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Message

Email Address

Website

http://

School District

School Grade

Name Of Teaching Artist

Proposed Dates / Time Frame

Proposed Art Integration

Classroom is:

Inclusive

Self-contained

Number of Students

Number of Students With Disabilities

Grade Levels

Federal Congressional District:

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MS State House District

MS State Senate District

Principal of School

Including the school principal's and classroom teacher's name indicates approval of this application.

First Name

Last Name

Classroom Teacher

First Name

Last Name