You must reside in the Bay Area
Please submit this application to be considered for all of Visual Aid's services, including the Voucher Program, Art Bank, Exhibition Program, Studio Assistant Program, and monthly workshops and Seminars.
Applications are reviewed on a quarterly basis:
Deadlines
.. Notification
April 16
..;May 16
August 15
..September 15
December 17
. ..January 17
Send form and materials to
Visual Aid 731 Market Street, Suite 600 San Francisco, CA. 94103
1. Date________________
Name________________________________________________________
Address _____________________________________________________
City/State/Zip__________________________________________________
County______________________________________
Telephone ___________________________________
2. Type of illness and date of diagnosis___________________________________________________
IMPORTANT: Please a letter from your physician or social worker substantiating your diagnosis..If such a letter is already on file with another organization (e.g. The San Francisco AIDS Foundation) a copy of that letter will be sufficient.
3. Please address the following questions on a separate piece of paper:
4. Enclose the following with your application:
5 .______I agree to allow curators, critics, dealers and other persons interested in my work to examine the visual materials in my application file.
_______Please keep my file closed to the public.
6. Art discipline(s) _______________________________________________________________
7. What materials do you primarily use?(This information is helpful for soliciting art materials manufacturers for donations to the Art bank.) _______________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
8. Grants, awards or honors received:______________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
9. How did you learn about Visual Aid's programs? __________________________________________
___________________________________________________________________________________
10. Person to contact in case of emergency:
Name ____________________________________________________________
Address ___________________________________________________________
City/State/Zip ______________________________Telephone ________________
11. I, the undersigned applicant, agree that the information on this application is true, and I give my permission for the administrators of Visual Aid to verify any of the information given in this application.
Applicant's signature _________________________________________Date ____________
All of the information on this application (except the visual materials, if the applicant so indicated) will be used only for confirming the applicants eligibility for Visual Aid's services or for compiling internal statistics tp analyze Visual Aid's programs
.
The following questions are optional and are asked for statistical purposes only. This information is helpful to Visual Aid when applying for grants to support its programs. Your answers are in no way used to determine your eligibility for Visual Aid's services.
Please Circle all that apply.
Ethnicity:
a. African American b. Native American c. Latino .d. Asian/Pacific Islander
e. Caucasian f. Other __________
Gender: a: male b. female
Orientation
a. gay/lesbian . b. bisexual c. heterosexual