2018 A PLACE OF HER OWN Application
Welcome! This is the application for 2018 A PLACE OF HER OWN: An arts based healing and transformation program and culminating exhibition. ***DUE November 19, 2017

Before you work on the form below, its best to read INFORMATION ABOUT PLACE (See link Below) , it contains a detailed explanation of the program, including a detailed descriptions and the schedule.

The class is limited to 15 Students. Applicants who successfully complete this application and review process, agree to the tuition, time and participation commitments, research evaluation process and confidentiality parameters of the program.

Students will be accepted and enrolled on a first-come-first-served basis. PLEASE text/email us when you have completed this application. You will be notified within 5 days of completing your application form to arrange an informational meeting with Cynthia Tom, Founder and Director and possibly a PLACE adviser. Following this meeting, you will be sent a final acceptance letter and notified of any preparatory meetings, forms, questionnaires or additional information needed.

Tuition is $2,000, which is non-refundable after the first 2 classes. Cynthia can help you with ideas to fund raise for yourself. Even with the tuition, PLACE is dependent on small grants, donors and a lot of volunteer hours to support this special project.

Warm regards, Cynthia Tom
PLACE Founder | Director | Curator
For questions: Cynthia Tom, text or call (415) 415-722-4296, aplace.sf@gmail.com

For a copy of the INFORMATION & SCHEDULE:
https://drive.google.com/file/d/0B8g4Ggs_LSePbUxQLTRId2NSWW8/view?usp=sharing

Email address *
First Name *
The name you want to be called
Your answer
Last Name *
Your last name
Your answer
What is your email address? *
(Note: Class communication is via email; pls. list the address you ALWAYS check.)
Your answer
What is your phone number? *
(If you do not have a phone, put "no phone")
Your answer
What is your address? *
Please give your address, city, state and zip code
Your answer
What is the year of your birth? *
Your answer
What is your ethnicity/ethnicities? *
Your answer
What is your highest level of education and field of study?
Your answer
Social Service/Volunteer Organization
Give the name of the social service or volunteer organization, if you are affiliated.
Your answer
Current relationship to the organzation listed above
What is your relationship to this organization? (staff, volunteer, alumni staff, client, etc.)
Your answer
Share with us how you serve your community?
Regardless if you are part of a non-profit or not, you can let us know how you are driven to serve the community
Your answer
Based on your understanding of the goals of the program, what are your goals in attending PLACE? *
Your answer
A PLACE OF HER OWN
Location, Location, Location
What is your racial group? *
(Please check all that apply - this remains anonymous and is for funding reports)
Required
What part of the program, in particular, appeals to you and why? *
Your answer
Why do you think you are a good candidate for this program? *
The target population are women who seek intuitive wisdom, strength, and balance to express themselves through art and storytelling. This process includes acknowledging and healing emotional patterns in your life and practicing new ways that open your heart and mind. In what ways do you think that you are a good candidate for this program?
Your answer
Is there anything else you want us to know about you? *
Your answer
Attendance and Participation: Your commitment *
It is very important that you attend each workshop. All the sessions (classes and art studio times, the SCRAP field trip [Class 9, Sat. Feb 24th) are structured on a progressive platform; one informs the next. In particular time to create your final art piece with Art Facilitators [Sessions 14-19] is vital. If you already know you will be unable to attend a sessions, the Director can help determine how adversely the absence will affect your ability to participate and complete the program.
Required
Do you have an interest, background, or experience in fine arts, arts and crafts or visual arts? *
Please elaborate. (NOTE: No previous art experience is required.)
Your answer
Tuition ($2,000): How you plan pay for your tuition (check all that apply) *
NOTE: The tuition is non-refundable. If you drop out after Class #2, which would be sad, we still need your full tuition.This is a grassroots effort and we rely on the tuition and fundraising to cover the cost of this semester program. This tuition could become a tax write off. We hope you understand. If you need ideas on how to raise the money for yourself contact Cynthia directly, aplace.sf@gmail.com.
Required
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