Creative Community Champions
Wednesdays from 22nd April until 1st July - Please note priority spaces will be given to those who have not completed a course with us previously.
Have you attended a course like this before with Art4Space?
*
Yes
No
If you have completed a Reaching Communities course with us before, can you say when and which course and also give a short statement why you want to enroll another course?
*
If you have not attended before, just put N/A
Name
*
First Name
Last Name
Email
*
example@example.com
Your email will be added to the monthly wellbeing newsletter from Art4Space unless you opt out below.
Opt out
Date of birth
*
-
Month
-
Day
Year
Date
Address
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Address line 1
Address Line 2
City
Borough
Postcode
Phone number
*
Preferred contact method
*
Email
Phone
Fine with both contact methods
Ethnicity
*
Arab
Asian/Asian British: Bangladeshi
Asian/Asian British: Chinese
Asian/Asian British: Indian
Asian/Asian British: Other
Asian/Asian British: Pakistani
Black/Black British British: African
Black/Black British British: Caribbean
Black/Black British British: Other
Mixed: Other
Mixed: White and Asian
Mixed: White and Black Caribbean
White British/Irish
Other Ethnic Group
White other
Prefer not to say
Gender
*
Female
Male
Non-binary
Transgender
Intersex
I prefer not to say
We are wanting this course to benefit those most in need. Are you able to tell us a little bit why you are applying:
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Can you confirm you can attend all the sessions 10am-12.30pm from 22nd April until 1st July (with break on 27th May)?
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Yes
No
Current Employment / Education:
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Full time employment
Part time employment
Full time education
Part time education
Low income
Registered Unemployed
Freelance
Other
Emergency Contact
*
Their full name
Relation to you
Phone
*
Emergency contact's number
If you are referred, please put referrer's details below - If not applicable put N/A
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Name of referrer
Title and Organisation
*
Referrer's telephone
Referrer's email
Do you have health conditions we should know about
Allergies
Do you consider yourself to have a disability? Do you have any learning or access needs we should know about?
Is there any ways you can think of that we can help you best access the course?
E.g. If English is not your first language, is there something we can support you with during the course?
Your place is funded. Things are tight across the sector, so if you’re able to offer a contribution, it helps us cover costs and keep offering funded places.
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