Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Race
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific Islander
Black/African American & White
Asian & White
American Indian/Alaskan Native & White
Native Hawaiian/Other Pacific Islander & White
American Indian/Alaskan Native & Black
Other Multi-Racial
Refused/No Response
Hispanic
Gender
Male
Other/Transgender
Female
Refused/No Response
Do you have a Special Need/Disability?
Yes
No
Household/Family Income
*
Extremely-Low Income (0-30% AMI)
Very-Income (31-50% AMI)
Low-Income (51-80% AMI)
Other Data
Homeless
Chronically Homeless
Female-Headed Households
Elderly
Frail Elderly
Persons with Severe Mental Illness
Persons with Developmental Disabilities
Persons with Physical Disabilities
Victims of Domestic Violence
Abused and Neglected Children
Injured Soldiers and Veterans
Persons with Alcohol and Drug Abuse
Persons living with HIV/AIDS
Large Families (5 or more members)
Refused/No Response
Geographic Data
*
Unincorporated El Paso County
Calhan
Fountain
Green Mountain Falls
Palmer Lake
Manitou Springs
Monument
Ramah
Are you currently:
MAC studio artist
Library Card Makerspace Member
Paid (access badge holder) Makerspace Member
None 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.
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