Name *

First Name

Last Name

Do you live in the Cincinnati area?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you currently a practicing artist? *

Yes

No

Have you lost your job or other paid opportunities due to COVID19?

Yes

No

I identify as: (select all that apply) (optional)

We are committed to equity and inclusion and view data as an essential tool to be accountable to this commitment. This information is being collected for tracking and reporting purposes and does not affect eligibility or selection.

Arab of Middle Eastern

Asian, South Asian, or Southeast Asian

Black or African-American

Latinx

Native or Indigenous

Native American, Alaskan Native, or Native Hawaiian

White or Caucasian

Biracial or Multiracial

Other

I prefer not to answer