Nomination Form

Thank you so much for your interest in the Juneteenth Oral History and Documentary Project from the City of Phoenix Commissions of Arts and Culture and Human Relations!
 
Following the establishment of Juneteenth as a federal holiday, we're looking for residents to share stories, memories, photos or memorabilia​ around celebrations of Juneteenth in Phoenix for a series of documentary videos. To nominate yourself or someone else for this project, please complete the following form, which is around 5 questions long and should take 5 to 10 minutes to complete. 

Please note: while all nomination forms will be considered, submitting a nomination does not guarantee that individuals will be contacted for an interview. Given the volume of submissions, we cannot respond to individual nominees. The City of Phoenix will reach out to selected individuals to move forward with interviews.


If you have any questions, reach out to the Phoenix Office of Arts and Culture at 602.262.4637 or arts.culture@phoenix.gov. Thank you so much for your sharing your story, we look forward to connecting with you soon!

Question Title

* Nominee Contact Information
Provide the name and contact information of the person you're nominating. If you're nominating yourself, enter your own information. If you're nominating someone else, you can enter your own information as an alternate contact. If you don't have their contact information, leave those fields blank.

Question Title

* Nominee Awareness
Is your nominee aware that you are nominating them for this project? Select the appropriate option below. If you are nominating yourself, select "Self".

Question Title

* Share your Juneteenth story
Tell us more about who you're nominating, what's their Juneteenth story, and why their experience is important for African American and Black history in Phoenix (200 words max)

Question Title

* Photographs and Other Materials
If you have any photographs, documents, memorabilia, or other materials you'd like to share with your story, select the appropriate options below.

Question Title

* Upload Photographs or Other Materials
If you would like to share your photographs or other materials with the project, feel free to upload them below. Please note: by uploading your materials, you are giving the City of Phoenix permission to share and promote your images on its websites, social media, or other digital and print platforms as part of this project. All attribution will be provided. All other rights remain with you.

PDF, PNG, JPG, JPEG file types only.
Choose File

Question Title

* Follow Up
Let us know how you would prefer to be contacted by selecting your preferred options below.

Question Title

* Phoenix City Council District
Select the Phoenix City council district of the person you're nominating. If you don't know their district, you can look up their district with the City of Phoenix. If they don't live in Phoenix, you can leave this field blank.

Question Title

* Gender or Gender Identification
Select the gender or gender identification of the person you're nominating.

Question Title

* Race and Ethnicity
Select the race and/or ethnicity of the person you're nominating. Please select all that apply.

Question Title

* Age
Select the age of the person you're nominating.

Question Title

* Public Records Policy
Before you submit this survey, we would like remind you about the city's policy on public records, which states that the information you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained according to city records retention policies. If you do not agree with this policy, do not submit this form.

T