Application First Name* Last Name* Street Address* Apt #/Floor City (Primary)* State (Primary)* - select -AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUnited States Minor Outlying IslandsUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory Postal Code (Primary)* Phone-Phone (Main)* Email* Country of Origin* United StatesAfghanistanBangladeshBhutanCanadaGuyanaIndiaMalaysiaNepalPakistanSaint LuciaSri LankaTrinidad and Tobago Age* Do you work, and if yes what do you do? What jobs do your parents do* What is your family’s annual income?* How many people live in your household?* Tell us about yourself.* Why do you want to be a part of this program?* What do you hope to gain from this program?* What skills do you think you can contribute to this program? (poetry,writing,visual arts, dancing etc)* What does art mean to you? What does justice mean to you?* How can we use art to achieve justice?* Where do you see anti-blackness in our community? How can we address it?* Do you agree with the Black Lives Matter movement's demand to defund the police? why or why not?*
