Urban Artisans Application
First Name
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Last Name
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Session
Address
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City
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State
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Zip
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Phone Number
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Email Address
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Social Security Number
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Date of Birth
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DD
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YYYY
Gender
Emergency Contact Name
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Relationship to you
Your answer
Current School
Your answer
Current Grade
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Race
How many people (including yourself) live in your household?
Your answer
Who do you live with?
Do you participate in a reduced lunch program at school?
Do you, your family or household receive any of the following
Required
What is the yearly income range of your household or family:
Do you have a diagnosed disability?
Required
By submitting this application I do hereby agree that any artwork that I produce in whole or in part as a participant in the Urban Artisans program, including, but not limited to, any and all paintings, sculptures, pottery, literary works, musical compositions, or recordings, are and shall remain the property if Urban Artisans, and I have no proprietary interest in said work.
I understand that the artwork that I produce may be used for publicity and/ or sold to fund the Urban Artisans program.
Photo Release and Medical Release
Please be sure to fill out the photo release and medical release forms with an ArtMix staff member.
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