IPUL Arts - Artist in Residence Report Form

Page 1

Information about you

Teaching Artist's Name

Mailing Address

City

State

Zip Code

Phone

Residency Information: Location

Location information

Name of School / Site

Address

City

State

Zip Code

Phone Number

Contact information

Name of Teacher

School Phone

Home / Cell Phone

Program Description

For this section, please answer the following questions in three to five brief sentences.

Please describe your residency project as it actually occurred. Did the project differ from what was proposed in your application? If so, how? (500 words or less please)

What goals and objectives did the project seek to achieve? Were these goals and objectives achieved? To what extent?

What problems occurred (if any) and how were they overcome ?

Briefly describe the teacher and staff you worked with n the school setting. Have teachers been able to implement the art ideas / techniques with students?

In what ways were you able to tie the residency to the needs of your students as they pertain to their IEP? (Gross/fine motor skills building, teamwork, social/emotional goals and so on).

In what ways were you able to tie the residency to the core curricula/21st century skills? (Humanities concepts, historical relevance and so on.)

Residency Information: Statistics

Start Date

End Date

Total Number of students who participated in the project.

Number of Students Being Served With Disabilities

Is This a Title One School?

YesNo

Number of Classrooms

Hours of Teaching per Classroom

Number of Artists That Participated

Number of Teachers and Paraprofessionals Involved

Total Number of Days for Project

Total Number of Teaching Hours for The Project

Page 2

Publicity

For this section, please answer the following questions in three to five brief sentences.

Demonstrate the ways you acknowledged IPUL and our logo in your project? (as outlined as a requirement in your application)

You can upload any scans of newspaper clippings, images, programs, invitations etc. in the publicity images link below. You can link to any social media you used to acknowledge IPUL either by pasting in a link in the text box above or a screen shot as a publicity image below.

Publicity images

Evaluation

For this section, please answer the following questions in three to five brief sentences.

1. Please give your honest evaluation of the project . (For instance would you like it to be larger / smaller? If so, why? Why was it a valuable project? Did the staff support this residency? Do you have future funding? what were the project's strengths and weaknesses? Would you apply for funds again? Why or why not?

2. Did you partner with any other organizations besides IPUL in your residency? If so, who?

3. What specific methods and strategies did you utilize to achieve the goals of your residency?

4. What specific skills did participants learn? What were they able to learn, know, and understand as a result of this experience? Were there any unexpected outcomes of your residency?

5. How did you evaluate student learning? What did success look like?

Learning outcomes

Please articulate and evaluate different aspects of your residency in the following section.

Learning outcome

Assessment Criteria:

Methods and results:

Actual Budget

This budget page should reflect actual income and expenses for the project.

Expenses:

Artist Salary

Supplies/rent for special projects

Other

Total Actual Expenses for Program

Income:

List cash and / or in-kind donations that were used for the program expenses.

Artist Salary($1000 awarded by IPUL Arts for this program

$0-500 awarded for previously approved travel or special events projects

Other Grant Money

Other (supply fees, etc)

Total Cash

Total

Uploads

You are required to upload 3 pictures of the project, as well as a scan of any photo release forms for any participants whose faces are visible. If you submit a picture without faces visible, you may upload a blank copy of a photo release form. There must be a photo release form with each picture.

You must do this at the same time you submit your report, and only in this format. No other channels for photos or releases will be accepted. If you have issues or questions about this - please contact us

This requirement must be met in order to process your submission for payment.

First Picture and Release Form

Required Picture # 1. Click the button below and choose the files you want to upload.

Required picture #1 release form - student's name and description must be included and clear so we can match them up with the picture.

Second Picture and Release Form

Required Picture # 2. Click the button below and choose the files you want to upload.

Required picture #2 release form - student's name and description must be included and clear so we can match them up with the picture

Third Picture and Release Form

Required Picture # 3. Click the button below and choose the files you want to upload.

Required picture #3 release form - student's name and description must be included and clear so we can match them up with the picture

Contact Information