Application for Assistance

Are you an artist or cultural worker?

Yes No

If yes, please indicate what type of artist you are in the field below.

Which of the following have you experienced? Select all that apply by holding the "⌘" button.

Surname / Family Name

First Name / Given Name

Pen Name / Nom de Plume

Pronouns

Date of Birth

Place of Birth

Nationality

Languages Spoken

Current Residential Address

Telephone Number

Website

Legal Status in Country of Origin: What is your immigration or visa status in the country where you were born?

Legal Status in Country of Residence:What is your legal, immigration or visa status in the country where you currently live? If you are a visa holder, please include expiration dates.

Marital Status

Married Single

Number of Children

Have you ever held a U.S. J visa?

Yes No

If yes, was it subject to a two-year residency requirement?

Yes No Unknown

If yes, please indicate the start and end dates below.

Complete Artist CV or Resume (.pdf, .doc, .docx)

Maximum file size: 10 MB
Allowed File Type: pdf, doc, docx
Please attach a CV, which include the titles, dates, and all pertinent information for published, exhibited, screened or performed works or art. Please provide links to websites showing your works of art.

Profession

Name of Current Employer

Employer Email

Employers Address

Employment Skills Unrelated to Art

Organizational Affiliation

Organizational Affiliation (Cont.) Indicate if you are a member or employee of a political or other organization. If necessary, please attach a separate document, of no more than 3-5 pages, marked “CIVIL AND POLITICAL ORGANISATIONS.”

Maximum file size: 20 MB
Allowed File Type: pdf, doc, docx
If necessary, please attach a separate document, of no more than 3-5 pages, marked “CIVIL AND POLITICAL ORGANIZATIONS.”

Please attach a separate document of no more than 3-5 pages titled “CURRENT SITUATION.” Describe your situation today, including answers to the following questions: 1. Where do you currently live? 2. If you still live in your country of origin, what danger/risks do you face? 3. If you have left your country of origin, are you able to return? 4. What kinds of travel and/or residency restrictions have been applied to you? 5. If you return to your country of origin, will you or members of your family face detention or danger? 6. Are you in touch with any other governments or organizations to help you seek refuge? (If so, please list them below along with any additional comments. We may be able to work on your case more efficiently if we know which other groups are involved.)

Maximum file size: 20 MB
Allowed File Type: pdf, doc, docx
Please attach a separate document of no more than 3-5 pages titled “CURRENT SITUATION.” Describe your situation today, including answers to the following questions: 1. Where do you currently live? 2. If you still live in your country of origin, what danger/risks do you face? 3. If you have left your country of origin, are you able to return? 4. What kinds of travel and/or residency restrictions have been applied to you? 5. If you return to your country of origin, will you or members of your family face detention or danger? 6. Are you in touch with any other governments or organizations to help you seek refuge? (If so, please list them below along with any additional comments. We may be able to work on your case more efficiently if we know which other groups are involved.)

Details of Attack, Threat, Persecution, or Censorship

Maximum file size: 20 MB
Allowed File Type: pdf,doc,docx
Please be sure to include: Date of arrest/attack/threat, place of arrest/attack/threat, and if detained: The length of time you were detained, the place of detention, forces who arrested/detained you, or the forces you believe were responsible and why you believe they were responsible. If arrested: The authority that issued the arrest warrant or made the decision, detailed description of all acts of persecution. Detailed description of all acts of censorship. Describe what you believe is the motivation of your attackers and why you believe this. Describe what you did after the attack or threat: for example, did you go to the police, appeal through the legal system for police protection or investigation, or appeal to humanitarian organizations for help? Please explain what happened as a result of your actions. For example, what, if anything, did the police do to help? If there are ADDITIONAL REASONS that you have received threats or ill-treatment other than your art, please explain. Additional reasons may include: persecution due to gender, sexual orientation, religious or social group, ethnic minority, perceived political opinion, etc.

Service Requested

Pro bono immigration representation for relocation to the United States Pro bono immigration representation for at-risk artists already in the United States Limited referral to pro bono immigration representation internationally Assistance connecting to artists residencies Assistance connecting to arts and advocacy organizations Assistance connecting with professional opportunities Assistance finding and applying to emergency funding