2025 Beautify the Barriers Application Survey

1.Contact Information(Required.)

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.Age (if under 18)

3.Number of barriers requesting to paint(Required.)

4.Artist Biography: Please tell us about yourself in 150 words or less. This will be used to introduce you at the reception and put on our website.(Required.)

5.Design Description: Briefly describe your design and its creative intentions within 150 words. This will also be used at the reception and put on our website. A sketch of your design must be included with this application.(Required.)

6.Upload a sketch of your proposed design. Please note that barrier must be painted to strictly mirror the approved design submitted with the application. While minor adjustments may be necessary to conform with physical aspects of the barrier, the design and concept of the painted barrier must mirror the design sketch submitted with this application. Any changes not pre-approved by the Library may result in Simpson Library, at its sole discretion, painting over or modifying the painted barrier.(Required.)

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7.Upload an example of your previous artwork.(Required.)

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8.Optional: Upload another example of your previous artwork.

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9.Please read and check the box next to each statement to indicate your understanding and agreement.(Required.)

All submissions shall become the property of Simpson Public Library and shall not be returned. They may be used by the Library, including but not limited to, for publicity or promotion.

No information contained in this submissions shall be deemed confidential. I have not submitted any information that may be deemed proprietary in nature.

The Library at its sole discretion reserves, without limitation, the right to:
a. Change any requirements in the application;
b. Reject any application it deems insufficient, not in keeping with the intent or spirit of this program, or for any other reason; and
c. Change or paint over any design that does not significantly match the submitted and approved design sketch or does not adhere to the design considerations laid out in the design guidelines in the sections below.

I understand that a design concept containing any of the following or similar will result in rejection of my application:
a. depicts or suggests the use of drugs, alcohol, tobacco, weapons, or violence;
b. depicts or involves nudity, sexual connotation, or innuendo;
c. degrades any individual or group on the basis of race, ethnic background, national origin, religion, gender, age, ability, or sexual orientation;
d. includes profane, obscene, or violent language or images;
e. depicts or suggests any other derogatory or negative messages or endorses illegal activities; or
f. references any social, cultural, religious, or political issues.

I affirm that my design:
a. considers the uneven surface conditions of the concrete barriers;
b. is solely the result of my artistic effort;
c. is unique, original, and does not infringe upon any copyright, trademark, or the rights of any person or company;
d. is positive and supportive of the local Mechanicsburg community; and
e. reflects the 2025 Summer Learning Program theme, “Color Our World”.

10.By typing my name (and parent/guardian name if under age 18) and today's date on the lines below and submitting this application, I affirm that I understand and agree to abide by all the statements in Question 9.(Required.)

Type your name. If applicant is under age 18, also type parent/guardian name.

Enter today's date.