The Potters’ Studio Sliding Scale Membership Application

Please complete the following questions to determine whether you qualify for our Supported membership stream. If you would like to add supplemental information, you can do so by sending any documents to memberships@berkeleypottersstudio.org. Your application and additional documentation will be kept confidential

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* 1. Please provide your first and last name:

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* 2. Please provide your email address:

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* 3. Please select the option you most closely identify with:

I experience difficulty meeting my basic needs for myself and dependents.

I may stress about meeting my basic needs for myself and/or dependents but still regularly meet them.

I am comfortably able to meet my basic needs for myself and/or dependents

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* 4. Please select the option you most closely identify with:

I have debts that prohibit me from meeting my basic needs.

I have some debt but it does not prohibit me from meeting my basic needs.

I have manageable debt or am debt-free.

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* 5. Please select the option you most closely identify with:

I rent lower-end property or have unstable housing.

I rent a property and am able to make rent regularly.

`I own my home or rent a higher-end property.

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* 6. Please select the option you most closely identify with:

I find it difficult to afford reliable, necessary transportation.

I have access to daily, reliable transportation.

I own or lease a car or have access to transportation without financial stress.

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* 7. Please select the option you most closely identify with:

I have limited or no savings and no access to family and/or financial support.

I have savings or access to family and/or financial support.

I have savings, investments, a retirement account or access to family financial support.

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* 8. Please select the option you most closely identify with:

I have limited or no expendable income.

I have some expendable income.

I have expendable income.

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* 9. Please select the option you most closely identify with:

I have barriers to accessing healthcare and/or affording ongoing medical expenses.

I can afford healthcare and some ongoing medical expenses.

I have high-quality healthcare and can easily afford medical expenses.

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* 10. Please select the option you most closely identify with:

I cannot afford to take time off work.

I can take a vacation or take time off work without financial burden.

I can afford to regularly travel or take vacations.

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* 11. Please select the option you most closely identify with:

My earning power is impeded by my immigration status, gender, race, disability, incarceration history, level of education and class background.

My earning power is unimpeded by my immigration status, gender, race, disability, incarceration history, level of education and class background.

I have a relatively high degree of earning power and my earning power is not impeded by my immigration status, gender, race, disability, incarceration history, level of education and class background.