GALLERY 37 APPLICATION
Please complete this form online, and get in touch if you would like assistance in completing the form as we are happy to help scribe or discuss contributions with you by phone or in person. Note any supporting creative material must be your choice to select.

If you would like a hard copy and/or wish to submit responses in an alternative format please get in touch with us via info@punch-records.co.uk

All information shared is treated confidentially and records held in accordance with current data protection legislation.

Email address *
NAME *
Your answer
ADDRESS *
Your answer
POSTCODE *
Your answer
NUMBER *
Your answer
ONLINE (Include Twitter, Instagram, Website) *
Your answer
AGE / DATE OF BIRTH *
Your answer
DO YOU HAVE ANY DEPENDENTS OR CAREGIVING RESPONSIBILITIES? *
DO YOU HAVE A REGISTERED DISABILITY, LONG TERM AND/OR CHRONIC HEALTH CONDITION? *
DO YOU HAVE ANY OTHER ACCESS NEEDS YOU WOULD LIKE TO DISCUSS AT THIS STAGE? (PLEASE OUTLINE)
Your answer
PLEASE LET US KNOW IF YOU WOULD PREFER TO SHARE AND DISCUSS YOUR ACCESS, HEALTH OR DISABILITY NEEDS YOU MAY HAVE IN PERSON AT THE SELECTION INTERVIEW?
Please Note
Any information shared in this section will not affect your selection or participation in the programme, we simply want to ensure we can make every reasonable effort to maximise your participation in the programme.
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