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  • Artists at Risk Connection Form

    Please fill out this form so that we may evaluate your circumstances and determine how we can best assist you. Fill out as many fields as you can. If there is information you do not have, skip the field. For required fields which do not apply to you, indicate "n/a". Responses to this form are encrypted. Your information will be treated as highly confidential.
  • Artist Information

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  • Referral Information

  • This section is only to be filled out if this form is being completed on behalf of the artist. If you, the artist, are filling the form out yourself, please skip.

  • Professional Information

  • Details of Attack, Threat, Persecution or Censorship

  • If you were detained , please fill out the following section:

  • If you suffered from any form of persecution, please describe:

  • If you suffered from any form of censorship, please describe:

  • Additional information:

  • Current Situation

  • Describe your situation today. For example, are you able to return to your country of origin? What kinds of travel and/or residency restrictions have been applied to you? If you return to your country of origin will you or members of your family face detention or danger?

     

  • Are you in touch with any other governments or organizations to help you seek refuge? If so, please list them below along with any additional comments. We will be able to work on your case more efficiently if we know which other groups are involved.

  • Nationality & Citizenship

  • Dependents

  • Please list the names of any dependents, if applicable (in most countries, legal dependents are defined as one’s spouse and children) who would accompany you in relocation. PLEASE NOTE that immigration laws in many countries may prevent you from bringing adults over the age of 21 on a dependent visa.

    If you have no dependents, indicate "n/a". 

     

  • Employment

  • Please provide information about your current or most recent employer.

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  • Education

  • If applicable, please list your academic degrees.

  • References

  • Additional Information

  • Should be Empty: