Program Scholarship Request for Schools and Community Orgs

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This form is to apply for subsidized, discounted, or free in-school and in-community interactive educational performances or workshops facilitated by Mojdeh Stoakley.

Mojdeh is an internationally recognized teaching and touring artist, educator, and public health worker hailing from Chicago (US). Her programs meet or exceed all US states expectations for Social and Emotional Learning standards (SEL) for school programs serving grades K-12. For more information please see www.mojdehstoakley.com

Email *

Name: First and Last *

Phone Number *

Type of Institution *

Community Organization (Art Center, Non-Profit, Faith-based Org, Park District, City Funded Org, etc)

School (serving children and youth)

University + Colleges (United States and Canada)

University (United Kingdom and Europe)

Other:

Name of Institution, School, or Community Group *

Location (city) *

Country *

United States

Canada

United Kingdom

Europe

Other:

What is your relationship with the institution you're making this request on behalf of *

Teacher (serving children and youth)

School Admin (serving children and youth)

Organization Administrator

Student Leader for a Campus Org (Colleges + Universities)

Campus Administrator (Colleges + Universities)

Other:

Type of program you're interested in

Workshop(s) only

Performances(s) ony

Both

Whatever we can make happen based on limitations of schedule

Other:

Clear selection

When would you like the program? *

Anytime

Specific date(s), month(s), term, season, etc.

If there are specific desired date(s), month(s), term(s), or season you'd like to host a program, please list them here.

Will this program be a part of an already scheduled event/festival? If yes, what is the name of the event/festival or share a link.

Please describe the ages and economic status of the populations served by your organization. (or link to a school report card or similar document)

Additional demographics for the population served. Please include anything your think is relevant (eg. race, faith, refugee, disability, etc) - especially if the population you serve experiences disparity or hardship as a result. (optional)

Why does your school/org deserve a subsidized, discounted, or free program?

If your school/org doesn't qualify for a free program does your school have funds it could contribute to offset program costs? *

Yes

Other:

If yes, what is the budget (or range) that your school/org could contribute to offset program costs for a one-time visit? *

Is there anything else you'd like to share, please use this area to add additional information and links.

Send me a copy of my responses.

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