1.What is your first name?

2.What is your last name?

3.Email Address

4.What city are you located in?

5.What is your zip code?

6.Organization Name

7.Project Title or Grant Number, if applicable

8.How has California Humanities funding supported your work or that of your organization?

9.What impact does California Humanities funding have on your community?

10.If you are a current grantee, what impact does losing California Humanities funding have on you, your organization and/or your community?

11.If you are an applicant, what impact does losing potential California Humanities funding have on you, your organization and your community?

12.As a grantee or applicant, how does California Humanities staff support your work?

13.Is there anything else you would like us to know?

*14.Is it ok for California Humanities staff to contact you about your story/example?(Required.)

Yes

No

*15.Sharing my story(Required.)

I consent to having my story/example shared anonymously, including use on California Humanities social media, website, eNews, or with our elected Officials.

I consent to having my story/example shared and would prefer it to be attributed to me by name, including use on California Humanities social media, website, eNews, or with our elected Officials.

I do not consent to having my story/example shared.