Urban Teachers Network Community Assistance Program (CAP) Application
Complete this application form to request CAP funds from UTN.
Organization (Donation) Applicants: Answer Questions 1-7 and 8a-8c.
Individual (Service Award) Applicants: Answer Questions 1-7 and 9a-9b.
ALL APPLICANTS: Must provide electronic signature and application date.
Visit UTN360.org for complete description of our mission and programs.
Type of Application *
NOTE: For service award requests, individuals must be students at an accredited community college or community activists and/or artivists.
1. Full Name of Nominee *
Your answer
2. Nominee Mailing address *
Your answer
3. Nominee Email Address *
Your answer
4. Nominee Phone Number *
Your answer
5. Nominated by: *
Include your full name and contact information (phone number and email address)
Your answer
6. Have you donated at least $20 to UTN during the previous six months? *
Required
7. Best ways to communicate with you? *
check ALL that apply.
Required
8a. For DONATION REQUEST (Organization): Please provide a short description of the nominated organization. Also discuss how the nominated organization promotes one or more of the following: 1) Culturally Relevant Curriculum and Hip Hop Pedagogy 2) Urban Artistic Expressions 3) Community Activism and Artivism 4) Media Literacy
Your answer
8b. Amount Requested:
Your answer
8c. Date Needed:
Your answer
9a. For SERVICE AWARD Nomination (Individual): Provide information on background and achievements of NOMINEE in urban arts education and/or civic and community involvement. Include reason(s) why you are nominating this individual for UTN's service award.
Your answer
9b. Is nominee a:
10. Electronic Signature *
Please type your full name on line below. This serves as your electronic signature for this application.
Your answer
Application Date *
MM
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