Program Scholarship Request for Schools and Community Orgs
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
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Email *
Name: First and Last *
Phone Number *
Type of Institution *
Name of Institution, School, or Community Group *
Location (city) *
Country *
What is your relationship with the institution you're making this request on behalf of *
Type of program you're interested in
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When would you like the program? *
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? *
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.
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