Applicant Name *

If you are filling out this form for someone else, please enter your name here. Your response will remain confidential and will not be publicly displayed with your name attached.

First Name

Last Name

Please select the class you received a scholarship for *

Weekly Beginner Adult Ceramics Classes

Weekly Intermediate Adult Ceramics Class

Weekly Children's Ceramic Classes

Other

Future Plans *

Do you plan to continue participating in ceramic classes in the future?

Yes

No

Marketing Consent *

I give my permission for Teralta Art to use my submission for marketing materials. I understand that this form is completely anonymous and anything shared will not be connected to my name.

I agree

Please do not share my submission for marketing purposes