INTAKE FORM Thank you for contacting me. How did you hear about my work? Presonal Website Instagram Facebook Google Presenter Residency Artist Funder University Client Referral Industry Referral Other Unknown Organization Name and Location Do you identify as a non-profit or foundation? Yes No Full name of point of contact * Your name here First Name Last Name Point of contact pronouns Point of contact phone number (###) ### #### Point of contact email address * Ideal date(s) for project MM DD YYYY Is this project multiple days? Yes No Unsure Presentation Location Where would jaamil be performing, teaching, or facilitating? Will this project be in-person or virtual? In-Person Virtual Both Uncertain Describe the type of project/event are you interested in me participating in? Academic Advising Creative Consultation Design Educational Lectures Energy Readings Facilitation Film Screenings Lectures Performance Performance Residency Poetry Readings Teaching Residency Other Estimated guest/audience count Estimated budget Please use this space for your website and/or any additional information. Thank you for contacting me. Someone from my team will be in touch shortly.
