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.
Organization - Donation Request
Individual - Service Award Request
1. Full Name of Nominee
2. Nominee Mailing address
3. Nominee Email Address
4. Nominee Phone Number
5. Nominated by:
Include your full name and contact information (phone number and email address)
6. Have you donated at least $20 to UTN during the previous six months?
7. Best ways to communicate with you?
check ALL that apply.
If nominee is selected, do you want to remain anonymous?
Yes, please do not include my name in award letter.
No, you can include name in award letter as "nominated by...."
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
8b. Amount Requested:
8c. Date Needed:
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.
9b. Is nominee a:
community activist and/or artivist?
student at an accredited community college?
10. Electronic Signature
Please type your full name on line below. This serves as your electronic signature for this application.
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