Youth Outreach Program Application Name Pronoun: Date of Birth: Age: Phone (Cell) Phone (Home) Street Address: City: Province Postal Code: Email: School: Grade: First Emergency Contact Name: First Emergency Contact Phone Number: Second Emergency Contact Name: Second Emergency Contact Phone Number: Allergies: Where did you find out about the Youth Outreach Program? Why are you interested in taking the Youth Outreach Program? What would you like to learn and achieve from the program? Describe your experience with art making. ***Please attach 3 examples of your artwork, in any medium: Apply Now! What's On / What's Next Keeping Time // Laura Peturson and Andrew Ackerman December 16, 2022 Martha Street Studio Pet Projects – Print Exchange July 12, 2022 2022 Inkubator Showcase December 16, 2022 Martha Street Studio 2022 Member’s Show + Sale November 4, 2022 Forlorn Visitations // Nat Cann August 24, 2022