|
Date:
|
|
Name:
|
|
Street:
|
City:
|
State:
|
|
Zip:
|
Home Phone:
|
|
Primary Business/School/Company Employment:
|
|
Position Title:
|
|
Employer's Street Address:
|
|
City:
|
State:
|
Zip:
|
|
Phone:
|
Fax:
|
|
Email:
|
Web Address:
|
| Company/Business/School (Check all that apply) |
| Public School |
Grades |
| District Name |
Principal |
| Charter?Yes No |
| Private School |
Grades |
| Affiliation |
Headmaster |
| Dance Studio |
Ages served |
| Recreational Program |
Ages served |
| Professional Dance Company |
| Semi-professional Dance Company |
| Amateur Dance Performing Group |
| Independent Artist |
| Artistic Collaborative |
| Arts Program |
| Health/Fitness Center |
| Church |
Affiliation |
| College/University |
| Local Arts Council |
| State Agency |
| Federal Agency |
| Other |
| Dance Program Content (Check all that apply) |
| Creative Movement Ballet Modern Jazz Ballroom Folk/Ethnic Clogging |
| Musical Theatre Square Dance Improvisation Choreography/Comp. Performance |
| History Technology Science/Med. Social (incl.line and hip-hop) Tap Other |
| I am interested in the following services (Check all that apply) |
| Educational professional development workshops or training |
| Self School Level District Level State Level Regional Level |
| National Level International Level Professional Company |
| Conference Presentation |
| State Regional National International Other |
Dance Informational or Special Programs (Curriculum, standards, frameworks, assessment,
accountability, technology, etc.) |
| Specify |
| Consulting (Program design, grant planning, teacher support, etc.) |
| Specify |
| Networking |
| Resources and Publications |
| For Dance Educators Only |
| Are you a: Full-time teacher Part-time teacher Consultant Administrator |
| Resident Artist Other |
| Are there others at your site who also teach dance? |
| Dance Education Specialist Full-time, how many? Part-time, how many? |
| Physical Educator Full-time, how many? Part-time, how many? |
| Resident Artists Full-time, how many? Part-time, how many? |
| Other Arts Educator Full-time, how many? Part-time, how many? |
| Is dance in your school (primary place of employment) part of: |
Physical Ed. Music Ed. Other Arts Extra-curricular activities
Dance Education is separate subject |
| If your school gives credits for dance, are these calculated into the student's GPA? Yes No |
| If yes, are these considered: Arts credit Physical Education credit |
| What is the approximate number of students participating in the dance program? |
| Elective (Number) Required (Number) Total number of students in school |
| Describe the average amount of time each student spends in dance over one year: |
# of weeks per year # of sessions per week #of minutes per session
# of total hours per year |
| Teaching levels: PreK-2 3-5 6-89-12 Higher Ed Adult |
Are you certified by your: State Professional Association
Which Professional Associations? |
| If you are certified by the State of South Carolina to teach dance, what type of certification do you have: |
| K-12 Dance Advanced Fine Arts (Dance) Critical Need (Dance) Other |
| If you teach in higher education, check all that apply for your institution: |
Dance major program Yes No
If yes, degrees granted |
| Dance minor program Yes No |
| Dance education certified program Yes No |
| Number of full-time faculty teaching dance |
| Number of part-time or adjunct faculty teaching dance |
| Do you teach at more than one school or business? If yes, then include name, address and contact information for each institution: |
| School Site #2 |
| Name: |
| Address: |
| Phone: |
Principal: |
| District: |
Grade levels: |
| School Site #3 |
| Name: |
| Address: |
| Phone: |
Principal: |
| District: |
Grade levels: |
|
|
|
|
