Diversity in Representation Fund – Applicant Intake Form

Applicant Information

This form collects information from individuals or teams applying to the Diversity in Representation Fund. The fund supports projects and participants that advance inclusive, equitable, and authentic representation in film and media, with an emphasis on reducing barriers to participation and professional advancement.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pronouns
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
An IndividualA TeamGuardian/Parent
Organization or Team Name
Participation Context
Producer/Team LeadDirectorWriterCinematography/CameraSoundActor/PerformerOther (please specify)Other
Brief statement (100–200 words): *

Please describe the circumstances that would prevent your team from registering without this support. We are seeking to understand the barriers you are facing and how registration coverage would make participation possible.0/200
Representation & Impact
Which communities does this project and/or applicant represent or center?*
If Other, please describe
Why does it matter to you, personally, to take part in a project like this—and what does your participation add that wouldn’t be there otherwise?*
(Consider authorship, leadership, on-screen representation, narrative perspective, or workforce impact.)
Registration Coverage Request
Seattle 48 Hour Film ProjectSeattle 48 Hour Horror Film ProjectMontana 48 Hour Film ProjectBay Area 48 Hour Film Project
New Team (never participated before)New team (participated before but new team leader/new crew)Existing team seeking registration assistance
Team Name*
Primary Team Contact Name*
If different than person filling out this form
Primary Team Contact Email*
example@example.com
Primary Team Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
I understand this fund covers team registration only and does not reimburse other production costs.*
Experience & Capacity

(First-time creators are encouraged to apply.)
Relevant experience of the applicant or team*
What support, mentorship, or access would be most helpful to you beyond funding?
Required Age Information
Under 1818–2425–3435–4445–5455+
I confirm a parent/guardian is aware of this application and will complete any required permissions for participation.
Additional
How did you hear about the Diversity in Representation Fund?
Certification & Acknowledgment
I certify that the information provided is accurate to the best of my knowledge.*
I understand that funds are limited and that not all applications can be supported.*
Applicant Full Name*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Signature*

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Date*

MonthDayYear
Date
Information collected through this application is used solely for the purpose of evaluating eligibility and administering the Diversity in Representation Fund. We do not sell, rent, or share personal information with third parties. Any data shared with partner organizations or funders will be anonymized and aggregated and will not include names or identifying details. Access to applicant information is limited to staff and reviewers directly involved in fund administration. By submitting this form, you acknowledge and agree to this use of your information. Questions may be directed to admin@create48.org.
Should be Empty:

Applicant Information

Participation Context

Representation & Impact

Registration Coverage Request

Experience & Capacity

Required Age Information

Additional

Certification & Acknowledgment