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* 1. Organization Name

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* 2. Address

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* 3. Name of Cultural Facility or Arts Venue (if none, please write N/A)

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* 4. Total revenue loss from Cultural Facility or Arts Venue closures in dollar amount (if your organization does not manage a space, enter 0):

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* 5. Total revenue loss from event and program cancellations in dollar amount:

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* 6. Total COVID-19 emergency-related expenses in dollar amount:

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* 7. Total employee reduction and job losses in dollar amount:

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* 8. Total days of Facility/Venue closed in March (if not applicable, type 0)

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* 9. Total attendance/visitor loss in March:

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* 10. In two (2) or three (3) sentences, briefly summarize the impact that COVID-19 has had on your organization during the month of March:

Please indicate your top three financial priorities and concerns at this time below:

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* 11. Financial Priority 1:

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* 12. Financial Priority 2:

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* 13. Financial Priority 3:

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* 14. Name of person completing this survey (for internal use only)

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* 15. Title of person completing this survey (for internal use only)

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* 16. Email address of the person completing this survey (for internal use only)

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* 17. Any additional comments, please list here:

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