Application for Volunteer Business and Legal Services

Name*

First NameLast Name

Professional Name

Website

Preferred Language

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Confidentiality Notice: To protect your confidential information, please do not include any confidential information in this application or during any initial discussions with GPAC staff or your volunteer. Confidential information should only be shared under the terms of an agreement between you and your volunteer.

Briefly describe the nature of the problem or need for which you are requesting assistance.*

Eligibility Requirements:

There are three criteria that we review to determine your eligibility to utilize this program.

Eligibility includes:

● Being a resident of Allegheny County, Pennsylvania

● Having an income level below 250% of the federal poverty level, as defined every January by the US Department of Health & Human Services

● Having a request that is related to your personal arts practice

Please provide material relevant to your request for assistance including your most recently completed federal tax return or other acceptable confirmation of income.*

Please list ALL names and addresses of additional parties involved with your legal request. For example, list other individuals, board members, corporations, attorneys, etc. involved with or against you. Attach additional pages if necessary. Enter N/A if not applicable*

Why do we ask for this? The volunteer involved in your request will need to make sure that there is no conflict of interest between anyone involved in this matter and the other clients they already represent.

By checking the box below, I hereby affirm that the information contained in this application is correct and, to the best of my knowledge, complete. This questionnaire fully and accurately describes the problem(s) for which the within named individual requests assistance. I understand that: (1) Greater Pittsburgh Arts Council (GPAC) cannot guarantee that a volunteer will agree to take on your request; (2) GPAC will not be responsible for the outcome of any request handled by a volunteer; (3) I am free to engage or decline any volunteer who may offer to assist; (4) the scope of any assistance by a volunteer is limited to the above described problem as may be further defined in any subsequent engagement letter or project summary between the volunteer and me; (5) The volunteer may withdraw from the engagement if I insist on taking action with which the volunteer has a fundamental disagreement or is beyond the objectives of the assistance; (6) GPAC does not make any representations or guarantees about the quality of services I will receive; (7) I will be advised by the volunteer, and not GPAC; and (8) I agree to promptly notify GPAC if I no longer require the services of a volunteer.

I hereby affirm that the information contained in this application is correct and, to the best of my knowledge, complete.*

Affirm

Greater Pittsburgh Arts Council funding sources frequently ask for documentation regarding who we have served. If it is determined that you are eligible for assistance, may we list your name? (Your answer does not affect your eligibility in any way.)

YesNo

I would like someone to contact us about membership in the Arts Council.

YesNo

The Arts Council has made a commitment to our funders and community to prioritize advancing diversity, equity, inclusion, and accessibility in all facets of our work. We collect demographic data to hold ourselves accountable to this commitment. The information you provide remains confidential and individual information will never be shared with anyone outside of our organization. If we do publish data on demographics, only statistical information — and no identifying information on individuals — will be shared. Submitting this information is completely voluntary, but we hope you’ll opt into participating.

Race