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"*" indicates required fields

Your Information

Name*

First Name Last Name

Pronouns (Check all that apply)

This helps us understand the correct way to address you.

She/Her

He/Him

They/Them

I prefer not to say

I will type them in...

Other

Primary Email Address*

Primary Email Address Type*

Work

Personal

I'd like to add a secondary email address*

Yes

Secondary Email Address*

Secondary Email Address Type*

Work

Personal

Primary Mailing Address*

For mailing raffle prizes, incentives, and important announcements.

Street Address City State / Province / Region ZIP / Postal Code Country

Phone Number*

Phone Number Type*

Work

Personal

How would you best describe yourself? (Select one)*

Alaskan Native

American Indian or Native American

Asian

Black or African American

Latinx

Middle Eastern

Multi-racial

Native Hawaiian or other Pacific Islander

White

Please indicate how you were trained:*

2-day virtual or in-person Facilitator Training led by AWBW staff

On-Demand Training

Agency Information

If your agency has a website, please put your agency name as it appears on the website. If you're not associated with an agency, please provide a name for your art program.

Agency Name*

Your Position*

My agency address is the same as my primary mailing address above.*

Yes

Agency Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Agency Website URL

Agency Type*

501c3/nonprofit

For-profit

Government agency

Other (please specify below)

Other

Service Areas & Settings

What is the primary service area of those you intend to serve through art workshops?*

Other

In which settings do you intend to offer workshops? (check all that apply)*

Other

Participant Information

What are the life experiences of those you intend to serve through art workshops? (check all that apply)*

Other

What is the primary age group you intend to serve through the art workshops? (Select one)*

Adults (18+)

Teens (13-17)

Children (0-12)

Children & Teens (0-17)

Families

Elders (65+)

Collaboration Agreement

AWBW Agrees to:

Grant access via individual online account to the Facilitator Dashboard that houses curriculum, resources, logs, and reports. Access will be removed if payment for the annual subscription fees is not received.
Offer ongoing comprehensive support via phone, email, and/or online.
Compile reports from workshop logs and participant evaluations upon request.
Share new workshops, resources, and other incentives via a bimonthly newsletter.
Offer professional development and wellness opportunities for facilitators in-person or virtually through peer-to-peer groups, Facilitator Enrichment Trainings, etc.
If applicable, provide an invoice for the annual subscription fee. If fee is not paid within 6 weeks after the invoice is sent, access will be removed.

AWBW terms*

I have read the above terms.

Windows Facilitator Agrees to:

Attend a formal training hosted by AWBW to become a Certified Windows Facilitator.
Facilitate art workshops, including AWBW and/or non-AWBW workshops (in one-on-one and/or group settings with adults, youth, children, agency staff and/or community members) using Windows philosophy and framework.
Notify AWBW if other staff at your agency want to participate in our train-the-trainer program, which consists of our on-demand training.
Contribute to the Community of Practice via mid-year surveys and annual evaluation.
Maintain the integrity of AWBW by refraining from sharing website account information with anyone.
Notify AWBW if you will no longer be facilitating art workshops and/or are leaving the agency.
Ensure agency makes payment of $100 for the annual agency subscription fee within 6 weeks of receiving email notification.

Facilitator Terms*

I have read and agree to the above terms.

Electronic Signature*

Please type your first and last name below along with today's date as your electronic signature. Example: Wendy Jones 1/15/2021. By submitting this form and your electronic signature, you agree to the terms outlined above.

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