The Jar of Love Fund Application

Name

First Name

Last Name

Pronouns

Public Name (if different from above)

Cell Phone Number

(###)

###

####

Current State of Residency

Los Angeles

Ethnicity

Please select from the drop down.

I identify as…

Please select that from the drop-down.

I am over 18 years of age.

True. I am eligible.

False I am not eligible.

What vocation do you identify as?

Please briefly describe your work within the arts.

Your answer below.

Please provide details on what you ideally plan to do with the microgrant (200 word max).

Provide a URL to your website, social media, press link, or any other digital presence that demonstrates your career in the arts.

Your answer below.

I can provide a W9 and Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). (required)

True. I am eligible.

False. I am not eligible.

How did you hear about the microgrant?

Other

Please tell us where you heard about the microgrant.