Encore Artist Workshop Request Form

This form is ONLY for Art-Reach Member Organizations who pay annual dues to Art-Reach.

This form is not affiliated with the ACCESS Philly program. For questions about ACCESS Philly, please click here.

To view the roster of Art-Reach Encore Artists, please click here.

Contact Information

Member Organization Name

First Name of Liaison Making Request

Last Name of Liaison Making Request

Liaison's Phone Number

Liaison's Email Address

Workshop Information

Encore Artist Choice

Requested Workshop

Please confirm the format of this workshop:

Virtual Workshop

In-person Workshop

Street Address

Address where workshop will take place

City

State

Zip Code

Requested Date

Alternate Date

Program Start Time

Number of Participants

Number of Staff

Number of Senior Clients (ages 55+)

Number of Adult Clients (ages 19-54)

Number of Teen Clients (ages 13-18)

Number of Child Clients (ages 0-12)

Total Tickets

Accessibility Information

Please note the number of participants who:

If the answer is 0, please leave the field blank.

Have a Cognitive Disability

Have a Physical Disability

Use a Wheelchair

Use a Walker

Have a Non Visual Disability or Medical Condition

Are Deaf or Hard of Hearing

Are Blind or Visually Impaired

Use a Service Animal

Use a Ventilator/Respirator

Notes to the Office

Contact Information