Academy in Motion Program Access Application Applicant Information:Thanks you so much for your interest in our AIM Program. A representative will contact you soon after form submission.Name of applicant organization or group:* Name of Person(s) completing this application:* First Last Emails of Person(s) completing this application:* Address of applicant organization or group:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone number of Person(s) completing this application:*Date of application submission:* MM slash DD slash YYYY Requested date(s) of Academy in Motion program usage:* MM slash DD slash YYYY Requested Academy in Motion programming (select all that apply):* Select All Painting Drawing Ceramics Mixed Media Crafts Please describe the event/project you are applying for and its overall purpose.*Age Breakdown (write estimated count of audience/people served listed below next to each age group)*Youth (under 18), Young adults (18-35), Adults served (35-61), Seniors served (62+), and Total Expected ImpactApplicant Need:The information collected below will be used to determine the applicant’s request for financial assistance. Please know that the Academy Center of the Arts is committed to our community and is willing to work inside of any budget. Financial support is not a barrier to AIM programming, but it is always helpful as a non-profit to offset costs when possible.Do students pay tuition for your organization or group's programming?* Yes No Would you like to apply for financial aid for our Academy in Motion Program?* Yes No If yes, are you able to pay 50% of the program costs?* Yes No Are you able to commit to having 10-15 participants attend the program?* Yes No Explain why and how the Academy’s Art in Motion program fulfills a need for your organization.*Please share if your organization has its own facilities/building where we can set up indoors during colder months and inclement weather.*Please share the number of staff or volunteers that are available to assist with this program.*Section Community Value:The information collected below will be used to learn about the organization’s potential impact of the project. What kind of impact will this project will have on the community? Be sure to share the content and quality of your program.*Share your intended target audiences and why your program is needed by those you wish to serve. This should include information on different demographics served.*Please share Underserved and Under-Represented Demographics who may be impacted by the project (if any, write estimated percentage served listed below next to each group).*Individuals of Limited Income, ALAANA (African, Latinx, Asian, Arab, and Native American) Populations, LGBTQ+ (Lesbian, Gay, Bi-sexual, Transgender, Queer, etc.) Populations, Individuals with Mental and Physical challenges, Military Members and Veterans, Homeless Populations, and OtherPlease share how your organization would acknowledge, to the greater community, how the Academy made your program possible through a discounted rental.*PhoneThis field is for validation purposes and should be left unchanged.