AEE Referral Form
Thank you for connecting with Arts Education Exchange. Please provide us with the following information and we will be in touch to arrange a meeting.
Email address *
Referral Partner Name
Your answer
Staff Name
Your answer
Contact phone number
Your answer
Date
MM
/
DD
/
YYYY
Name of referral
Your answer
Age of referral
Your answer
How does the referral describe their gender?
Which of these describes the referral's current education and work status?
Does the referral experience or are they affected by any of the following?
What activities are the referral interested in?
Can you describe some of the challenges the referral has experienced that have led to the referral?
Your answer
If you know the name of the project you wish to refer to, please write it here:
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Any other relevant info:
Your answer
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