Taking Care Fund Application

Please visit the Theatre Washington website for eligibility information. If you have any questions about your eligibility, please contact Cody Whitfield at takingcare@theatrewashington.org.

IMPORTANT: Please be sure to complete all questions so that the Advisory Panel has your full information to consider during the review process. Thank you.

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* 1. Applicant Information:

Professional/Chosen Name

Legal Name (If different)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. For how many years have you been working professionally in the Washington theater community?

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* 3. Are you a person living with a disability?

Yes

Prefer not to answer

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* 4. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Another race or ethnicity, please describe below

Self-describe below:

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* 5. Do you identify as transgender or another non-cisgender identity?

Yes

Prefer not to answer

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* 6. What organizations are you a member of, if any?

AEA - Actors Equity Association

ATPAM - Association of Theatrical Press Agents and Manager

SAG/AFTRA -Screen Actors Guild, AFTRA

IATSE -International Alliance of Theatrical Stage Employees

SDC -Stage Directors and Choreography Society

AGVA -American Guild of Variety Artists

USA -United Scenic Artists

AFM -American Federation of Musicians

Other (please specify)

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* 7. In what capacities have you most recently worked in Washington theatre?

Actor

Administrator

Choreographer

Director

Designer

Technical

Stage Manager

Musician

Other (please specify)

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* 8. Most Recent Theatre Projects:

Dates

Theatre Name

Production Name

Position or Role

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* 9. Most Recent Theatre Projects:

Dates

Theatre Name

Production Name

Position or Role

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* 10. Most Recent Theatre Projects:

Dates

Theatre Name

Production Name

Position or Role

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* 11. Is there anything more you would like to say about your projects and production work?

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* 12. Are you currently employed?

Full-time

Part-time

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* 13. If you are employed full-time or part-time, please list your employer(s).

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* 14. Purpose of financial assistance:

Expenses because of non-medical emergency

Expenses related to dependent care

Out of pocket medical expenses

Other (please specify)

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* 15. Please describe your emergency need for financial support.

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* 16. If you are a parent, legal guardian, or caregiver, please provide a brief description.

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* 17. Do you have other sources of assistance (i.e. unemployment, grants, family/friends)?

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* 18. What is the combined CURRENT MONTHLY income for your household (you and spouse or significant other with whom you share finances; not group house members or roommates)?

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* 19. What is the combined balance in your checking and savings account(s)?

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* 20. If you have any significant outstanding debt, please describe below.

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* 21. Amount of assistance requested to cover expenses:

$500

Up to $1,000

Up to $1,500

Up to $2,000

Up to $2,500

Other (please specify)

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* 22. What is the timeframe in which you need to receive this assistance?

Next 30 Days

30-60 Days

90 Days or more

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* 23. Do you have health insurance?

Yes

Other (please specify)

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* 24. I have read and understand the Taking Care assistance
guidelines as provided in this application. I attest that all
information provided in this application is accurate and has
not been misrepresented in any way.

Yes

Taking Care Fund Application

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* 1. Applicant Information:

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* 2. For how many years have you been working professionally in the Washington theater community?

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* 3. Are you a person living with a disability?

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* 4. What is your race or ethnicity?

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* 5. Do you identify as transgender or another non-cisgender identity?

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* 6. What organizations are you a member of, if any?

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* 7. In what capacities have you most recently worked in Washington theatre?

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* 8. Most Recent Theatre Projects:

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* 9. Most Recent Theatre Projects:

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* 10. Most Recent Theatre Projects:

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* 11. Is there anything more you would like to say about your projects and production work?

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* 12. Are you currently employed?

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* 13. If you are employed full-time or part-time, please list your employer(s).

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* 14. Purpose of financial assistance:

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* 15. Please describe your emergency need for financial support.

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* 16. If you are a parent, legal guardian, or caregiver, please provide a brief description.

Question Title

* 17. Do you have other sources of assistance (i.e. unemployment, grants, family/friends)?

Question Title

* 18. What is the combined CURRENT MONTHLY income for your household (you and spouse or significant other with whom you share finances; not group house members or roommates)?

Question Title

* 19. What is the combined balance in your checking and savings account(s)?

Question Title

* 20. If you have any significant outstanding debt, please describe below.

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* 21. Amount of assistance requested to cover expenses:

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* 22. What is the timeframe in which you need to receive this assistance?

Question Title

* 23. Do you have health insurance?

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* 24. I have read and understand the Taking Care assistanceguidelines as provided in this application. I attest that allinformation provided in this application is accurate and hasnot been misrepresented in any way.

* 24. I have read and understand the Taking Care assistance
guidelines as provided in this application. I attest that all
information provided in this application is accurate and has
not been misrepresented in any way.