Are you submitting for yourself or on behalf of someone else? *

Myself

Someone Else

Name of Person Requiring Funds *

First Name

Last Name

Your Name (if submitting on behalf of someone else)

First Name

Last Name

Does the person requiring funds identify as disabled? *

You must be disabled to qualify for these funds

Yes

Does the person requiring funds identify as black, indigenous, and/or a person of color? *

You must be BIPOC to qualify for these funds

Yes

Are you a United States resident? *

For now these funds are limited to U.S. residents

Yes

Types of Roles Held in Film/TV *

Please check all that apply

Producer

Director

Screenwriter

Actor

Editor

Director of Photography

Sound Mixer

Production Designer

Other (please describe in the box below)

Do you certify that all information here is correct? *

Yes