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.
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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 *
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? *
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:
10. Electronic Signature *
Please type your full name on line below. This serves as your electronic signature for this application.
Application Date *
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