WSU Brushes with Cancer Participation Agreement -2023
Email *
Twist Out Cancer
Artist and Inspiration Profile Form and Agreement
Background Information
Wayne State University (WSU) has partnered with Twist Out Cancer (TOC) to bring the Brushes with Cancer program to the Art Dept at WSU. The Brushes with Cancer program provides psycho-social support to those touched by cancer to improve the quality of life for cancer patients, their family and loved ones, through a unique art experience.  Brushes with Cancer strategically matches artists with those touched by cancer to create unique pieces of artwork reflective of their journey. Over a period of 6 months, selected pairs will connect in person, via zoom, on the phone or email. Their relationships are guided and supported by WSU and Twist Out Cancer staff and program mentors with the intention of creating a support system for both the artist and subject. The program finishes on a high note with an art exhibition and auction where the artwork and stories are revealed and celebrated. All proceeds raised from the art auction will go towards further Twist Out Cancer's work in the community.
First Name *
Last Name *
Pronouns *
For example: they/she/he/xe
Please indicate your role with this Brushes with Cancer program. All roles will complete this agreement. *
Required
Birth Year
Address *
Home Phone Number *
Mobile Phone *
Work Phone
Preferred Phone *
Please Select One
Required
Occupation
Employer
Are you interested in being featured in our blog about your experiences as an inspiration or artist?
Are you interested in recording an audio podcast later in the year with your match to be featured on our website? *
Time Commitment
Your participation in Brushes with Cancer means that you are required to connect with your respective inspiration or artist at minimum on 6 occasions. A Brushes with Cancer mentor will connect with you individually once a month to ensure that the process is meaningful.
This project requires a minimum commitment of six connections with your assigned match either by phone, email, Facetime or in person if and when it is deemed safe to do so. Are you able to make that commitment for a successful project? *
Required
We ask that all program participants, mentors and volunteers are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors onto others in the program and commit to respecting others in the program. *
Required
Please read the following statement carefully and type your first and last name in the box below to acknowledge that you understand these expectations:  "The Brushes with Cancer program is designed to cultivate a connection between the artist and inspiration (with support from the program mentors, staff, and the TOC community as a whole). The art is a tangible product of that connection and intended to illustrate a part of their specific cancer experience - either a moment or as a whole. Willingness to share is required of both the artist and the inspiration. The artist is charged with listening and extracting elements from the inspiration's experience to integrate into the art.  The inspiration is not encouraged to direct or dictate the composition of the art work.  It is an exchange of trust that can generate unexpected interactions and meaningful connections." Type your name below to agree that you acknowledge this statement. *
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