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Artist Interest Form
First Name
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Last Name
*
Salutation
*
Ms
Mr.
E-mail
*
Phone Number
*
Address 1
*
Apt. #
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zipcode
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Artist Website Address
How did you hear about Arts Horizons?
*
Arts Horizons Website
Google Search
Referral
Attended AH Event
Attended Conference w/AH
Other
If Other, please explain
Who can we thank for referring you to Arts Horizons?
Have you been fingerprinted in NYC and/or NJ?
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Yes, in NYC and NJ.
Yes, in NYC only.
Yes, in NJ only.
I have not been fingerprinted in either state.
Please indicate all the art forms in which you are proficient. (Check all that apply)
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Dance
Drama
Music
New Media/Technology
Literary
Visual Arts
Other
Other
Do you have a car?
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Yes
No
Please list the location(s) to which you are willing or have access to travel.
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All New York City
Bronx
Brooklyn
Manhattan
Queens
Staten Island
Long Island
Westchester
Northern New Jersey
Central New Jersey
Southern New Jersey
All New Jersey
Which of the following populations do you have experiences teaching?
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Early Childhood
School Aged Children
Autism
Blind
Deaf
Health Care/Hospitals
At Risk Youth
Adults
Seniors
Teachers
Special Ed
Other
Other
Describe/List a professional development workshop you have conducted.
0/1000 characters
Describe/List an arts-education lesson plan you have administered.
0/1000 characters
Please provide a brief artist bio.
*
0/1000 characters
Please attach a current resume that includes your artistic and teaching experiences.
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