Workforce Development Grant Funded Membership Eligibility

Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Race

WhiteBlack/African AmericanAsianAmerican Indian/Alaskan NativeNative Hawaiian/Other Pacific IslanderBlack/African American & WhiteAsian & WhiteAmerican Indian/Alaskan Native & WhiteNative Hawaiian/Other Pacific Islander & WhiteAmerican Indian/Alaskan Native & BlackOther Multi-RacialRefused/No ResponseHispanic
Gender

MaleOther/TransgenderFemaleRefused/No Response
Do you have a Special Need/Disability?

YesNo
Household/Family Income*

Extremely-Low Income (0-30% AMI)Very-Income (31-50% AMI)Low-Income (51-80% AMI)
Other Data

HomelessChronically HomelessFemale-Headed HouseholdsElderlyFrail ElderlyPersons with Severe Mental IllnessPersons with Developmental DisabilitiesPersons with Physical DisabilitiesVictims of Domestic ViolenceAbused and Neglected ChildrenInjured Soldiers and VeteransPersons with Alcohol and Drug AbusePersons living with HIV/AIDSLarge Families (5 or more members)Refused/No Response
Geographic Data*

Unincorporated El Paso CountyCalhanFountainGreen Mountain FallsPalmer LakeManitou SpringsMonumentRamah
Are you currently:

MAC studio artistLibrary Card Makerspace MemberPaid (access badge holder) Makerspace MemberNone of the above
Please upload a copy of your most recent HOUSEHOLD payslips or W2s (jpeg, pdf, png) or other documents (tax return) that support your financial eligibility for this grant-funded membership OR drop off a copy at the MAC front desk.

We take the security of your personal information seriously, and as such this information is locked and stored in a safe area away from the public.
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