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ABOUT YOU

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* 1. First and Last Name

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* 2. Pronouns
This helps us understand the correct way to address you. Select all that apply.

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* 3. Agency Name (where you facilitate art workshops)
If you're not associated with an agency, please provide the name of your art program.

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* 4. Agency website URL:

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* 5. Your Position / Title

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* 6. Primary Email Address

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* 7. Primary Email Address Type

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* 8. I'd like to add a secondary email address (so we can keep in touch should you move on from your organization)

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* 9. Secondary Email Address

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* 10. Secondary Email Address Type

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* 11. What are your academic credentials (if applicable)? (e.g., LCSW, MFT, MA Ed., etc.)

YOUR WORK

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* 12. Do you offer art workshops outside of the United States?

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* 13. If you answered "Yes" to question 20, please share which countries.

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* 14. Do you facilitate art workshops in languages other than English?

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* 15. If you answered "Yes" to question 14, please share which languages.

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* 16. What percentage of your art workshops are one-on-one?

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* 17. What percentage of your art workshops are with groups?

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* 18. How else do you use art beyond direct client work? (select all that apply)

YOUR INDIVIDUAL YEARLY REACH

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* 19. Please provide the estimated total number of unduplicated individuals you personally served through AWBW workshops this year. Count each participant only once. Please include fellow staff, family, and friends you facilitated with.

Annual estimated unique individuals served:

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* 20. From participants reported above, what percentage consists of families of two or more individuals? Family relationships can include parents, children, siblings, grandparents, aunts, uncles, and more.

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* 21. What is the primary age group you serve through art workshops? Select one.

MEASURING IMPACT: HOW DOES ART HELP?
Please rate the impact of art workshops based on your personal observations of participants’ experience this year.

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* 22. The art workshops helped participants feel more positive about their future.

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* 23. The art workshops helped participants build resilience.

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* 24. The art workshops helped build and improve adult-child relationships.

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* 25. The art workshops helped build and improve relationships between participants and others in their lives.

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* 26. The art workshops helped participants build a sense of self-efficacy and agency.

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* 27. The art workshops helped participants strengthen adaptive skills and self-regulatory capacities.

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* 28. Would you or your organization have an art program without the support of AWBW?

YOUR ART WORKSHOP PARTICIPANTS
What percentage of your participants are from the following ethnic backgrounds? Your total allocation across all ethnic backgrounds should add up to 100%. Please use your best estimations. 

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* 29. What percentage of your participants are Alaskan Native?

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* 30. What percentage of your participants are American Indian or Native American?

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* 31. What percentage of your participants are Asian?

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* 32. What percentage of your participants are Black or African American?

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* 33. What percentage of your participants are Latinx?

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* 34. What percentage of your participants are Middle Eastern?

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* 35. What percentage of your participants are multi-racial?

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* 36. What percentage of your participants are Native Hawaiian or other Pacific Islander?

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* 37. What percentage of your participants are White?

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* 38. What percentage of your participants are of an ethnicity not listed above?

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* 39. For participants whose ethnic identities are not listed above, please specify their ethnicities below.

What are the gender identities of your participants? Your total allocation across all gender identities should add up to 100%. Please use your best estimations. 

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* 40. What percentage of your participants identify as female?

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* 41. What percentage of your participants identify as male?

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* 42. What percentage of your participants identify as non-binary?

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* 43. What percentage of your participants identify as transgender?

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* 44. What percentage of your participants have a gender identity not listed above?

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* 45. For participants whose gender identities are not listed above, please specify how they identify below.

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* 46. What percentage of your participants are at or below the Federal Poverty Line?
Website: 2025 Federal Poverty Level Guidelines

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PROFESSIONAL & PERSONAL IMPACT

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* 47. How would you rate the level of stress and burnout in your life?

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* 48. How would you rate the impact of our program in bringing about positive change in your personal life?

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* 49. How would you rate the impact of our program in bringing about positive change in your professional life?

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* 50. Simply spreading the word about AWBW's trainings and resources can make an impact. Would you like to join our Training & Outreach Team to help share about our upcoming trainings?

IN YOUR WORDS...
Your voice and experience are vital to the work we do together and to the communities we serve. We are deeply grateful for your willingness to share this powerful work. The following questions invite you to share your own experience, and your participation is completely voluntary.

By continuing, you are providing A Window Between Worlds permission to share the words you write. If you do not wish for your words to be shared, please do not complete this section.

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* 51. AWBW may share the following: (select all that apply)

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* 52. How has art been a tool for resilience and repair—for you, your community, or others?

Please share examples of how you have used art to facilitate connection, healing, or recovery during recent community challenges (such as natural disasters, economic stress, or social disruption).

We also welcome submissions on your personal practice for navigating crisis, or your vision for using art in response to future challenges.

We invite you to share below OR capture a quick video testimonial by visiting our Memory Fox page here.

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* 53. Please share one word that captures what AWBW means to you.

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* 54. Is there anything else you'd like to share with us?

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