APPLICATION FORM: COMMUNITY ART & DATA LAB with No Longer Empty at Kings County Hospital
No Longer Empty's Summer Project in collaboration with Kings County Hospital, July 1- 31, 2017

Instructions: To apply to be a part of this program, please complete the following application. Young people ages 14 through 18 are invited to apply, as well as seniors age 65 and up. The deadline to submit an application is June 21, 2017 at midnight. If you need help with your application, please call (917) 426-2666, email sara@nolongerempty.org, or come visit us on Saturday June 17 from 2-6pm at Kings County Hospital, 451 Clarkson, Brooklyn, NY 11203 (C Building, room CG91, near the intersection with E. 37th Street). Interviews with prospective applicants will be held after June 21st, and applicants will be notified shortly afterwards as to the status of their application.

1. First Name
Your answer
2. Last Name
Your answer
3. Date of Birth
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4. Address (Street number & name, Apt. number)
Your answer
5. City
Your answer
6. Zip code
Your answer
7. What neighborhood do you live in?
Your answer
8. If you are attending school, please list the name and address of your school or program:
Your answer
9. What is the highest level of education you have completed?
Your answer
10. How did you hear about this program?
11. Email Address
Your answer
12. Cell Phone
Your answer
13. Home phone
Your answer
14. Are you a member or regular visitor of any community organizations or centers in East Flatbush? If yes, please list which ones.
Please provide a brief answer in paragraph form, not to exceed 300 words.
Your answer
15. Why are you interested in being a part of this program?
Please provide a brief answer in paragraph form, not to exceed 300 words.
Your answer
16. How do you think art is being used as resource in your community?
Please provide a brief answer in paragraph form, not to exceed 300 words.
Your answer
17. What kind of free resources or services would you like to see in a community art space in your neighborhood?
Please provide a brief answer in paragraph form, not to exceed 300 words.
Your answer
17. Has art played a role in your life? Please explain.
Please provide a brief answer in paragraph form, not to exceed 300 words.
Your answer
18. If accepted to the program, would you be able to attend all sessions? The lab will meet four times a week (Wed-Sat, 2-6pm) and on July 30 and 31 from 12-6pm.
Your answer
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