Art Economic Empowerment Initiative Sign Up Form (Cohort I: July 2022

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Art Economic Empowerment Initiative Sign Up Form (Cohort I: July 2022 - December 2022)

Complete the entire form. Incomplete forms will result in disqualification from program selection. Slots are limited, this is first come first serve. To qualify you must be a Pennsylvania resident. Deadline is 06.30.22 11:59PM EST. For any questions, send an email to Info@TheWCE.org.

Email *

Preferred First & Last Name *

Telephone Number *

City & State *

Zip Code *

List your congressional district number? (To find your district go to https://www.house.gov/representatives/find-your-representative) *

Check the box/boxes that best describes your artistic discipline(s). *

Musician/Instrumentalist

Vocalist/Vocal Performer

Theater

Film

Digital/Graphics

Dance/Movement

Visual Arts

Spoken Word/Storytelling

Multidisciplinary

Crafts/Sculpture

Other:

Required

Check the box that best identifies the stage you are today in your artistic career. *

Emerging Artist (Beginning stages of artistic career development but not yet established a solid reputation as an artist amongst art critics or art buyers)

Mid-Career Artist (An artist who has created an independent body of work over a number of years and who has received regional or national recognition through publication or public presentation of their work)

Professional Artist (An artist who is at a mature stage in their career and who has created an extensive body of independent work. An established artist has reached an advanced level of achievement by sustaining a nationally or internationally recognized contribution to the discipline)

Other:

Required

Race/Ethnicity *

American Indian or Alaskan Native

Asian

Bi-racial or Multi-racial

Black, African American, or Afro-Caribbean Ancestry

Hispanic, Latino or Spanish Origin

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Other:

Required

Pronouns *

She/Her

He/Him

They/Them

Ze/Hir/Zir

Other:

Do you identify as transgender? *

Yes

List Your Generation *

The Silent Generation (1928 - 1945)

The Baby Boomer (1946 - 1964)

Generation X (1965 - 1979)

Millenial Generation (1980 - 1996)

Gen Z (1997 - 2015)

Do you identify as a person with a disability? *

No, I do not identify as a person with a disability

Yes, I have a sensory impairment (vision)

Yes, I have a sensory impairment (hearing)

Yes, I have a mobility impairment (movement)

Yes, I have a seen or unseen disability not listed

Required

List any accessibility accommodations, if needed.

All sessions will be virtual. Are you able to fully commit to the listed dates and times? Cohort I: July 20, 2022 6:00pm - 8:30pm EST; August 24, 2022 6:00pm - 8:30pm EST; September 21, 2022 6:00pm - 8:30pm EST; October 19, 2022 6:00pm - 8:30pm EST; November 23, 2022 6:00pm - 8:30pm EST; & December 21, 2022 6:00pm - 8:30pm EST (*Note - You must complete all sessions in order to receive the stipend and certificate of completion.) *

Yes

How did you hear about the Art Economic Empowerment Initiative? *

Website

Social Media

Past Attendee

Previous Event

Personal Recommendation

Other:

Required

Have you participated in any past workshops/webinars with The Women's Coalition for Empowerment, Inc.? *

Yes

If selected to participate in the AEEI, will you commit to the entire program? *

Yes

What do you hope to gain from the Art Economic Empowerment Initiative (AEEI)? *

Send me a copy of my responses.

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