Arts & Culture Empowerment Program

Arts & Culture Empowerment Program

Applicant Name*

Contact Name (if different from applicant)

Organization Name

Does your organization have non-profit 501(c)(3) status?

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Email Address*

Phone Number*

Referred by

Site Address (if known)

e.g. 1120 SW 5TH

Brief Description

Please briefly describe what assistance you are seeking (for example: convert an existing space artist(s) studios or maker space, lease space for performance or rehearsal, improve space)

Will you need a building permit?

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Are you Black, Indigenous or a person of color?

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Is the primary mission of your organization to serve Black, Indigenous, or Persons of Color (if applicable)?

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Do you have a disability as defined by the American Disability Act (ADA)?

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Is the primary mission of your organization to serve persons with disabilities as defined by the American Disability Act (ADA)?

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Any additional information about the community you serve?

for example a focus on youth, homeless, or LGBTQ+

Voluntary Information

The Voluntary Information section keeps our process and programs inclusive and diverse. We check these statistics to determine our impact on a diverse representation. This information will assist us in adjusting our outreach and program as needed. Please know that our team deeply values the needs of the community and your information is kept in strict confidentiality. We strongly encourage you to complete the form in its entirety.

Race/Ethnicity of Applicant

(please check all that apply)

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Primary Race/Ethnicity of Community served by organization

(please check all that apply)

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Gender of Applicant

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Primary Gender of Community served by organization

(please check all that apply)

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Additional information

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