CEDA Street Art Mural Application

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* 1. Address

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Date of birth

Applicants must be between 16 - 24

Date

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* 3. Please include a sample of your work

PDF, PNG, JPG, JPEG, GIF file types only.

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* 4. Please describe what comes to mind when you think of Community Action in your neighborhood. Is there a significant person or organization that best represents community services in your neighborhood? What is your initial plan for an 4'x4' mural that best represents your community and support within your community?

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* 5. What organization or individual referred you?