(chose
file from your browser at the top, then select print to use this form,
Please fill out the form and mail to
the
address at the bottom of this page)
Name:
______________________________________________
Date: ____/_____/____
Address:
_________________________________________________________________________________
City/Zip:
____________________________________________Phone (s): ____________________________
E Mail:
____________________________ Date of Birth ___________________________________________
Describe
your primary area of endeavor (painting, sculpture, photography, etc)
the number of years you
have
been committed to your artistic goals, and why you are applying to the
fund for assistance:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Amount requested
(maximum $2000) $______________
Please
include your CV and documentation of the emergency
Please
send your request to: William A. Graham Artist
Emergency Fund
P.O. Box 7528,
Houston, TX 77270 |