USA Application Form

Please fill out one form for each program you wish to enroll in.

Please enroll me in your:

	ArtLink Program [for 3rd-12th grade classes] ($600 per class)
	ArtLink Program with Videoconferencing [for 6th-12th grade classes] ($700 per class)
	Rainforest Artlink Program with Videoconferencing[for 3rd-12th grade classes] ($700** per class)

Discounts (up to a maximum of 10%):
5% ($30)	Early enrollment by May 31.
10% ($60)	Schools enrolling 3 or more classes, 10% off for each class

Creative Connections pays the international shipping costs of all materials your class exchanges. Your school needs only pay domestic postage to ship your class’ work to our office in Connecticut. Do not send us payment with this form. We will invoice your school once the matching process is completed. If applying for scholarship funding, make sure you fill out the scholarship request section near the end of this form.

General Information

Name of School:		Name of Principal, Director or School Head:
School Phone:		School Fax:
School Address, Street:		Address Line 2:
Town/City		State
Postal Code		Country
School Year Details: Opening, Closing and Major Vacation Dates:

Teachers participating in the program:

Our programs are designed to be an interdisciplinary study. Please provide information for the primary contact and any other participating teacher:

Primary Teacher

Name of Teacher:		Subject Taught:
E-Mail Address:		Teacher's Cell Phone:
Best Time to Phone Teacher at School:		Teacher's Home Phone:

Teacher

Name of Teacher:		Subject Taught:
E-Mail Address:		Teacher's Cell Phone:
Best Time to Phone Teacher at School:		Teacher's Home Phone:

Teacher

Name of Teacher:		Subject Taught:
E-Mail Address:		Teacher's Cell Phone:
Best Time to Phone Teacher at School:		Teacher's Home Phone:

Participating Class Information

Please fill an additional form for each class participating

Number of classes participating:		Age(s):
Grade(s):		Class Size:
Does your class have internet access?	Yes

Address to send information to (if different than school address):

Address, Street:		Address Line 2:
Town/City		State
Postal Code		Country

Creative Connections gives limited need-based scholarship for classrooms to participate in our programs. If applying for financial assistance, please state the basis for your financial aid application:

Partner Country Requests

Below is a list of our 2010-2011 partner countries, which we anticipate being with us again in 2011-2012. You have the opportunity to indicate the specific country(ies) you wish to partner with. We will endeavor to give you your 1st, 2nd or 3rd choice, but please be aware that we have a limited number of partner classes at any given grade level in each country. If your preference country is unavailable, we will contact you as soon as possible to discuss alternative choices. Please indicate your 1st, 2nd and 3rd choices below.

ArtLink Argentina Bermuda Brazil Cambodia Chile China Colombia Cyprus England Ecuador Guatemala Hungary India Indonesia Ireland Japan	Kazakhstan Kenya Latvia Mexico Nepal New Zealand Nicaragua Nigeria Northern Ireland Panama Poland Russia Sri Lanka Uganda	ArtLink Plus Brazil Chile China Gambia India Japan Kazakhstan Kenya Latvia Mexico Nepal Nigeria Poland Russia Sri Lanka Uganda
Rain Forest ArtLink Belize Colombia Guatemala Mexico Panama	Arab US Artlink Egypt Jordan	Photo VTC Canada Ireland Mexico Northern Ireland Russia

1st Choice:
2nd Choice:
3rd Choice:

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Mathews Park, 303 West Avenue, Norwalk, CT 06850 | 203-803-4376 | WorldLink@CreativeConnections.org