Create New York: Building community through the arts
It will take 10-15 mins to complete survey

A partnership program between Theatre Development Fund (tdf) and community centers across New York City, like The Dream Center, that engages New Yorker's, twenty-one and older, who want to interact with their city and give back to their communities by using the performing arts as a way to promote change in oneself, one’s neighborhood, and, ultimately, one’s city.

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* 1. Last Name:

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* 2. First Name:

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* 3. Home Address:

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* 4. Please provide your:

Cell Phone #
Home Phone #
Work Phone #

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* 5. Primary E-mail Address:

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* 6. Age Range: Please check a box that best describes you. You must be 21 or older to participate.

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* 7. What languages do you speak?

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* 8. What is/are your preferred language(s)?

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* 9. Emergency Contact's Full Name:

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* 10. Emergency Contact’s #:

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* 11. Emergency Contact’s Relationship to you:

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* 12. What is the best form of communication for you? Please put a check mark next to your answer.

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* 13. What is your occupation(s)? Answer if applicable.

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* 14. What are the hours of your work schedule(s)?

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* 15. How long have you been affiliated with The Dream Center of Harlem?

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* 16. What attracted you to The Dream Center Harlem?

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* 17. Why did you apply to be a part of the Create New York: Building Community through Theater program?

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* 18. What are some of your hobbies that you like to do during your free time?

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* 19. What is your favorite thing about the Harlem community currently? Why?

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* 20. What do you think could enrich your community and/or your life in Harlem? Why?

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* 21. Do you see live performance playing a role in who you are?

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* 22. Do you see live performance playing a role in your community?

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* 23. Do you currently live in Harlem?

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* 24. If you answered no to the previous question, where do you live?

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* 25. How often do you see Broadway performances?

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* 26. How often do you see Off-Broadway performances?

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* 27. How often do you see local artists perform in your community?

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* 28. What artistic disciplines interest you most? Please check all that apply.

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* 29. Have you ever been a part of a live performance?

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* 30. Time Commitment Information:

The Create New York program consists of four live performance outings in conjunction with post-performance discussions at local restaurants. After the four outings and four discussions, we get together to solidify and plan the community based project we wish to pursue.

What to Expect:

-Four Performance Outings

-Four Discussions either on the same date as the performance or on a future scheduled date.

-The time commitment for the community project depends on what the project is. We will have project planning sessions and create task force teams so that everyone has a specific focus and equal responsibilities. The team will have the full support from the Artist Liaison and the TDF REP.

-Execution of the Community project event


What days and time of day would work best for you?

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* 31. Can you dedicate 8 afternoons or evenings over the course of the year without reservation for performance outings/discussions?

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* 32. Are there dates that you already have commitments for? If yes, that is okay!
Please list the days and times of your commitments.

For example, let us know if you participate in any extra-curricular activities such as an exercise class, book club, etc. or if you have prior commitments such as college courses or taking care of family members, etc.

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* 33. Do you plan to be in New York for the next three years?

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* 34. Additional Comments.

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