ArtiFactory Programming First Name Last Name Your email address Organization? Title of Program ClassWorkshopDevelopmentExhibitCommunity EngagementRehearsalOther Type of Event? PublicPrivate Promotion? NoneWebsiteSocial MediaEmail Description of Program Reason this program is important to do? How Does It Further Our Mission? Estimate of Community Members Impacted? Location? Main HallStageGalleryStudio Common AreaKitchenExternal Location Where is the external Location? Desired Start Date? Start Time? —Please choose an option—12:00 AM12:30 AM1:00 AM1:30 AM2:00 AM2:30 AM3:00 AM3:30 AM4:00 AM4:30 AM5:00 AM5:30 AM6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM10:30 PM11:00 PM11:30 PM End Time? —Please choose an option—12:00 AM12:30 AM1:00 AM1:30 AM2:00 AM2:30 AM3:00 AM3:30 AM4:00 AM4:30 AM5:00 AM5:30 AM6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM10:30 PM11:00 PM11:30 PM Frequency? One-timeDailyWeeklyMonthlyQuarterlyOther Other Frequency? Duration of Program? Resources Required From ArtiFactory: Board Participation? YesNo Materials? Equipment? TablesChairsLights (Life Drawing)Model StandEaselsMicrowaveRefrigeratorStove Other Needs? How will the program be funded? FeeDonationGrantRentalNo Revenue Fee Amount? Will the presenter be paid?YesNo In what form? Grant Source?