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Creative Medicine Program Application
* Indicates required question
Email
*
Your email
Name & Pronouns
*
Your answer
Email
*
Your answer
Instagram/Social Media Account
Your answer
Phone number
*
Your answer
Creative Medium/Apparatus
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Your answer
What project are you working on or what would you like to work on during this program?
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Your answer
What do you hope to get out of this program?
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Your answer
Our Program is $1,000 for 8 weeks of study. Are you financially able to afford this commitment?
*
Yes
No
Other:
Comments/Questions
Your answer
Send me a copy of my responses.
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