2022 Arts & Economic Prosperity 6 Participation Form

WE NEED YOUR HELP TO COMPLETE THE 2022 AEP6 STUDY IN WASHTENAW COUNTY

The study requires that we collect detailed information from eligible nonprofit arts and cultural organizations. Your charge (if you accept it) is to acquire 50 surveys from individuals attending your arts and cultural performances, events and exhibitions that take place throughout Washtenaw County.

We THANK YOU for your participation!

Please complete and submit this form to include your event(s) in the AEP6 Study. Thank you!

Events must take place before May 31, 2023.

Nonprofit Arts + Creative Organization Name*

Including all organizations producing or presenting arts, creative, culture, historic, heritage, festivals, events etc. regardless of whether arts + creativity is the primary mission.

Nonprofit designation*

IRS 501(c)... and registered as a nonprofit in the State of Michigan
Only an IRS 501(c)....
Only registered as a nonprofit in the State of Michigan
Education or Government Agency
I'm not really sure.

Tax ID number (TIN or EIN)*

If you do not know your number, use 000

Year Founded*

If unsure, provide an estimated date.

Website*

Audiences served*

Please indicate if your mission includes serving or if more than 50% of your audiences/attendees identify as any of the following. You may select more than one.

Select All
BIPOC (Black, Indigenous, People of Color)
ALAANA (African, Latinx, Asian, Arab, Native American)
LGBQT+
Children (pre-K to 18)
People with disabilities (any age)
Seniors (65 years +)
Specific cultural or ethnic population
No specific audience accounts for 50% or more of our attendees

You indicated that you served a specific cultural or ethnic population. Please identify that population. Thank you.*

We ask so we can best report who is served by Washtenaw's arts + creative organizations for advocacy etc.

You indicated that you served people with disabilities. Please, what disability or disabilities do you serve? Thank you.

We ask so we can best report who is served by Washtenaw's arts + creative organizations for advocacy etc.

Primary Contact Name*

First Last

Email*

Phone*

Organization Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Brief description of organization and mission:*

Your team and/or volunteer availability

A team will be needed at your event(s) to distribute and collect completed paper surveys. Please let us know if you have that covered or need assistance.

We DO have staff, volunteers and/or ushers to conduct the survey.
We DO NOT have staff and/or volunteers to conduct the survey and need assistance.
Not sure yet, please check back with us.

Events to survey - Add up to three options

Identify up to three possible public events you are presenting before April 30, 2023 to survey. If you present more than one art form, or have a signature event, please note that in your description.

Creative Washtenaw will contact you to confirm one or more for you to actually survey.

No more than 50 surveys should be collected at any one event. If your audience is less than 50, you may be asked to survey more than one event.

How many events options do you want to submit?

One event option
Two event options
Three event options

All Events are located at the same address*

Yes, same venue address for all events.
No, event addresses are different
Three event options

Event Option 1 - Name of Event*

Event Option 1 - Date*

Event Option 1 - Start Time*

:

Event Option 1 - Estimated number of attendees*

Event Option 1 - Venue name*

Event Option 1 - Location Address*

Street Address Address Line 2 City State ZIP Code

Event Option 1 - Event description*

Please remember that surveys must be completed on site at the event.

Event Option 2 - Name of Event*

Event Option #2 - Date*

Event Option 2 - Start Time*

:

Event Option 2 - Estimated number of attendees*

Event Option 2 - Venue name*

Event Option 2 - Location Address*

Street Address Address Line 2 City State ZIP Code

Event Option 2- Event Description*

Please remember that surveys must be completed on site at the event.

Event Option 3 - Name of Event*

Event #3 Date*

Event #3 Start Time*

:

Event Option 3 - Estimated number of attendees*

Event Option 3 - Venue name*

Event Option 3 - Location Address*

Street Address Address Line 2 City State ZIP Code

Event Option 3- Description of Event*

Please remember that surveys must be completed on site at the event.

Additional comments/questions

Thank you for your submission

Creative Washtenaw will soon be back in touch with you to confirm the events you should survey and provide additional instructions.

If you have questions. please contact Deb & Hannah at:

AEP6_Survey@creativewashtenaw.org or at 734-213-2733.

You and your team are appreciated!

Email

This field is for validation purposes and should be left unchanged.

2022 Arts & Economic Prosperity 6 (AEP6) Participation Form

WE NEED YOUR HELP TO COMPLETE THE 2022 AEP6 STUDY IN WASHTENAW COUNTY

Please complete and submit this form to include your event(s) in the AEP6 Study. Thank you!

Events to survey - Add up to three options

Thank you for your submission

MEMBERSHIP