Art in Action: Imagination Moves the Mind

Information Request Form

Note: Fields marked with an asterisk (*) are required.

First Name*: Last Name*:

Address*: City*:

State*: ZIP*:

Phone*: ( ) Home Work Mobile

Email*:

How do you prefer to be contacted?* Phone Email Mail

Position*: Principal Teacher Parent PTA President Other:

School*: Public Private Parochial

School Address*: City: State: ZIP:

School Phone*: ( ) Fax: ( ) Web site:

Grades*: (e.g., K-5) Total enrollment*:

Current art program status*:	No art Art teacher Art with regular teachers
	Artist in residence program:
	After school art program:
	Other:

I would like more information about*: (Check all that apply)	School curriculum Summer ARTcamp ARTboxes
	Art shows Training Volunteering Donating
	Other:

How did you hear about Art in Action?*

	Art in Action Web site	Newspaper/Magazine:
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		Art in Action affiliated school: