DMT/BCF/AUS Stage Lighting Tech Fellowship for Womxn and People of African Descent
Full Name *
How did you hear about this? *
Please be specific, if someone shared it with you, please list their name.
Required
Email Address *
Mailing Address *
Phone number *
Are you Black/Person of African Descent? *
Ethnicity *
Nationality/Ethnic Group/Tribe
Age *
Do you identify as a Woman? *
Required
Gender (how do you self identify?) *
Why do you want to participate in this fellowship (200 word max) *
Bio (200 words max) *
Link to public online profile/website/portfolio *
Do you have any experience in stage production? Technical or otherwise? Please describe. *
Are you able to climb a ladder and lift up to 25lbs? *
Are you able to complete the entire fellowship? *
Please see below for required dates, check each date to confirm
Required
MEDIA RELEASE *
Throughout Afro Urban Society’s and Dance Mission's programs, we may photograph and or video record participants during classes and events. These photos and/or videos may be displayed on Afro Urban Society’s and Dance Mission's printed materials, website or Social Media pages and are used to support our outreach, marketing, publicity and fundraising efforts.By signing below you agree to: hereby irrevocably give Afro Urban Society and Dance Mission the right and permission to copyright and/or publish, reproduce or otherwise use your/your child’s name, voice and likeness and/or written material, photographs and audio-visual about me or by me (or my child) for instruction, art, advertising or any other lawful purpose. Afro Urban Society and Dance Mission will own any and all rights of said photographs and video perpetuity.
Anything else we should know?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service