Digital Art & Technology Access Application Winter/Spring 2023

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Thank you for applying to Digital Art & Technology Access (DATA)!

DATA is a program for neurodivergent youth ages 13-26. Once this form is submitted, you will receive a confirmation email within 72 business hours.

Winter/Spring 2023 schedule:
February 18 - April 15
Saturdays 10 am–1 pm

at Squeaky Wheel's NEW LOCATION

Tri-Main Center

2495 Main St, Buffalo, Suite 310

If you have any questions or need assistance filling out this form, please email caroline@squeaky.org

*All information is confidential and for internal use only

Email *

I'd like to attend the following workshop(s)

[please check all the workshops you'd like to attend]

Session 1- Digital Tools - Feb 18 & 25

Session 2 - Prop Design - March 4 - 18

Session 3 - Stop Motion Animation - March 25 - April 15

Required

Student Name *

Student Age *

Current School and Grade Level *

Do you need transportation assistance? (we may be able to provide you with financial support towards transportation on a first come first served needs basis.) *

Yes

Any allergies or medical issues that we should be aware of? (we will be providing snacks, please note any food allergies or restrictions below) *

Yes

If "yes," please specify.

Things the student likes *

Things the student dislikes *

Student has experience in animation

Yes

Other:

Clear selection

Student has experience in digital art

Yes

Other:

Clear selection

Parent/Guardian Name *

Parent/Guardian Phone Number *

Parent/Guardian Email *

Home Zip Code *

Emergency Contact Name and Phone number (if same as parent/guardian write N/A) *

Is the student currently receiving services from the Office for People With Developmental Disabilities (OPWDD)? *

Yes

Would you like to learn more about applying for services through the Office for People With Developmental Disabilities (OPWDD)? We can set you up with someone to assist you at no cost. *

Yes

How did you find out about DATA? *

Our website

Facebook/Social Media

From a friend

Kids out & About Buffalo

Other:

I grant to Squeaky Wheel/Buffalo Media Resources the right to take photographs/video of family members and workshop participants in connection with this workshop. I authorize Squeaky Wheel/Buffalo Media Resources Inc., its assigns and transferees to copyright, use, and publish this media in print and/or electronically. I agree that Squeaky Wheel/Buffalo Media Resources Inc. may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. *

Yes

Send me a copy of my responses.

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