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2. Teacher Name
3. Teacher Email
5. School or District
7. School Address
9. City
10. State
11. Zip
13. Grade Level
14. Number of Participating Classes
15. Approximate Number of Participating Students
17. Preferred Semester
    -- Select One --Fall 2017Spring 2018Either
18. Preferred Arts Discipline
    -- Select One --Visual ArtsMusicCreative WritingAny of the above
20. This year we are offering STEAM residencies in partnership with the Watershed Committee of the Ozarks. These residencies include 2 classroom visits, a field trip to the Springfield Art Museum and a field trip to the Watershed Center at Valley Water Mill. Which of the following statements best describes your interest?
    -- Select One --I am only applying for the STEAM residency.I am open to considering the STEAM residency.I am not applying for a STEAM residency.
22. If you are not applying for a STEAM residency, what content area, curricular standards or learning goals would you like this project to address?
24. Schedule Preferences
    If you already know the days of the week when Placeworks visits will best work with your schedule during the 2017-18 school year, please let us know. If you are unsure, just type "TBD."
26. How did you hear about Placeworks?
    -- Select One --Art Museum websiteCFO websiteFacebookbrochureanother teacher in my building shared infoword of mouthother
28. Thank you!
    We will be in touch regarding your application at the beginning of the 2017-18 school year. In the meantime, feel free to contact Kate Baird at kbaird@springfieldmo.gov with questions or concerns.
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30. 1. Receive an email copy of this form.
31. Email address

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