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ABOUT YOU
Questions 2-8 are optional.

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* 1. First and Last Name

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* 2. Pronouns (check all that apply)
This helps us understand the correct way to address you.

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* 3. Job Title

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* 4. Agency Name

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* 5. Work E-mail Address

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* 6. Personal E-mail Address (for backup purposes only)

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* 7. What are your academic credentials (if applicable)? (e.g., LCSW, MFT, MA Ed., etc.)

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* 8. Preferred Mailing Address (to mail raffle prizes, incentives, and important announcements)

WHERE YOU WORK

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* 10. What settings do you offer workshops in? (check all that apply)

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* 11. What percentage of your art workshops are one-on-one?

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i We adjusted the number you entered based on the slider’s scale.

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* 12. What percentage of your art workshops are with groups?

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i We adjusted the number you entered based on the slider’s scale.

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* 13. Do you use participant artwork to communicate with community stakeholders and donors?

YOUR INDIVIDUAL YEARLY REACH

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* 14. The following information helps us demonstrate our effectiveness across the nation. Thank you for taking a moment to provide your answers.

Please share the estimated total number of unique individuals you personally served via AWBW workshops this year. In addition to your regular participants, please include fellow staff, family, and friends with whom you created art.

Annual estimated unique individuals served:

HOW DOES ART HELP?
Please rate the efficacy of art workshops based on your overall observations of participants’ experience this year.
YOUR ART WORKSHOP PARTICIPANTS

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* 22. What life experiences do you address when facilitating art workshops? (check all that apply)

What percentage of your participants are from the following ethnic backgrounds? Use your best estimate based on your observations.

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* 23. What percentage of your participants are Asian/Pacific Islander?

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i We adjusted the number you entered based on the slider’s scale.

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* 24. What percentage of your participants are Black?

0% of participants 50% of participants 100% of participants
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 25. What percentage of your participants are Indigenous/Native American?

0% of participants 50% of participants 100% of participants
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 26. What percentage of your participants are Latinx?

0% of participants 50% of participants 100% of participants
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 27. What percentage of your participants are Middle Eastern?

0% of participants 50% of participants 100% of participants
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 28. What percentage of your participants are multi-racial?

0% of participants 50% of participants 100% of participants
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 29. What percentage of your participants are white?

0% of participants 50% of participants 100% of participants
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 30. What percentage of your participants are of an ethnicity not listed above?

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Clear
i We adjusted the number you entered based on the slider’s scale.

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* 31. For participants whose ethnic identities are not listed above, please specify their ethnicities below.

What are the gender identities of your participants?

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* 32. What percentage of your participants identify as female?

0% of participants 50% of participants 100% of participants
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 33. What percentage of your participants identify as male?

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Clear
i We adjusted the number you entered based on the slider’s scale.

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* 34. What percentage of your participants identify as non-binary?

0% of participants 50% of participants 100% of participants
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 35. What percentage of your participants identify as transgender?

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Clear
i We adjusted the number you entered based on the slider’s scale.

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* 36. What percentage of your participants identify as a gender not listed above?

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Clear
i We adjusted the number you entered based on the slider’s scale.

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* 37. For participants whose gender identities are not listed above, please specify how they identify below.

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* 38. What percentage of your participants are at or below the Federal Poverty Line?
Website: 2021 Federal Poverty Level Guidelines

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i We adjusted the number you entered based on the slider’s scale.

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* 39. Anything else you'd like to share with us?

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