Diversity in Representation Fund – Applicant Intake Form

Applicant Information

This form collects information from individuals or teams applying to the Seattle, Montana, Portland-OR, or Bay Area 48 Hour Film Project 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.
Are you applying as
Organization or Team Name
Participation Context
Applicant role on the team

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
Which event are you requesting registration coverage for?
Team Registration Type
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
Age range
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
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