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* 1. Applicant First and Last Name

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* 2. Applicant E-Mail Address

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* 3. Applicant Mailing Address (funds will be mailed to this address)

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* 4. Are you a resident of Allegany County or work/sell artwork in Allegany County?  (In order to be eligible for this relief fund, you must be a resident of Allegany County or work in Allegany County)

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* 5. Are you a current artist, sustainer, advocate, patron or lifetime member of the Allegany Arts Council? (To be eligible for this relief fund, you must be a current artist member, sustainer, patron, advocate or lifetime member in good standing).

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* 6. Which artistic disciplines do you practice?

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* 7. Have you lost income due to the COVID-19 pandemic, including a reduction in artwork sales, canceled performances or lost revenue, deposits or payments? If yes, please explain.

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* 8. Do you derive more than 30% of your annual, personal income from artistic endeavors (i.e., artworks for sale, performances, acting jobs, authoring, appearances, teaching, etc.)

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* 9. What is the minimum amount of funding needed to cover your basic needs at this time? (Applicants may not receive more than $250 in relief funding)

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* 10. Please provide some evidence of your active artistic practice such as a link to your website, social media page, a link to your platforms such as SoundCloud or links to Vimeo, etc.

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