Ages: 18 years and Up
Name
First Name
Middle Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
Male
Female
N/A
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
E-mail Address
example@example.com
What is your artistic discipline?
Company name (if applicable)
How many years have you been dedicated to your artistic work?
Describe your artistic experience so far?
What are your career/professional development goals?
Explain how you see yourself as an arts leader?
How would participating in the Black Arts Development-Mentorship program support your work?
0/300
If selected, after completing this program what would you create or desire to take all that you have learned to the next level?
What qualities or skills would you like in your mentor?
What area do you need the most support in?
Compensation will be $1200 to be offered at the end of successful completion of the program. Will you be fully committed to meet with your mentor for 4 hours each month from January 2023 - December 2023 ?
Yes
No
If accepted your requirements in receiving $1200 honorarium will be to attend all mentorship sessions. If you miss 4 sessions you will loose your spot and not receive the honorarium Do you understand?
Yes
No
File Upload (headshot) JPEG, PNG :
*
Browse Files
Cancel
of
Upload Artistic Resume/CV (if applicable)
Browse Files
Cancel
of
By signing you certify all above information is accurate:
Submit Application
Clear Form
Should be Empty: