New Student Enrollment Form

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New Student Enrollment Form

QUESTIONS?

Contact our Program Coordinator at coordinator@artistscreatingtogether.org or (616) 885-5866

Student Information

Student Name:*

Street Address:*

City:*

State:*

Zip Code:*

County:*

Type of Residence*

Private Residence

Group Home

Other

If residence type is Other, please describe:

Does ACT contact the student directly?*

Yes

If yes, list student phone number:

What type of phone is this?

Mobile

Home

Work

If yes, list student email address:

If ACT does not contact student directly, list name of student’s contact person:

Contact person’s relationship to student:

Contact person's phone number:

What type of phone is this?

Mobile

Home

Work

Contact person’s email address:

Artists Creating Together empowers individuals with disabilities to learn, grow, and celebrate through the arts.

Artists Creating Together is a 501c3 nonprofit organization. Our EIN is 84 - 1698531.

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Student Information

Join Our E-Mail List!

Our Supporters

Thank you for making ACT possible.

Join Our
E-Mail List!