MCA LAYOFF RELIEF FUND – Request Form for Former MCA Staff

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You are invited to fill out this form if you are one of the people laid off or otherwise out-of-work by the Museum of Contemporary Art–Chicago since March 2020, and are seeking financial support. The people organizing this attempt at raising support money are other laid-off former MCA workers. Please note that we cannot guarantee that we can meet all requests in full, but, based on responses to this form, we will disburse any money raised through the GoFundMe (https://www.gofundme.com/f/mca-layoff-relief-fund) to as many former staff as possible who have been affected by the MCA's policies and layoffs. We hope to disburse funds by the end of February 2021.

Email *

Name *

Pronouns

Phone Number

Is there any demographic information about yourself that you want to share? (This could include: Your race, gender, or other aspect.) (OPTIONAL)

What was your role at MCA? *

Were you a full-time or part-time worker? *

Full-time

Part-time

Other:

What is the date when you lost work? *

YYYY

How much money are you requesting? (This can be a range) *

Do you have any specific asks or needs related to the amount of money you receive? (For example: are you asking for funding so you can refuse to sign a severance agreement?) (OPTIONAL)

What is the best way to pay you digitally? *

Cash App

PayPal

Venmo

Zelle

Other:

Required

What username or number do we need to use in order to pay you on your preferred platform?

Are there other ways that you would like to be supported? (OPTIONAL)

Are there other ways you would like to offer support? (OPTIONAL)

Do you have any feedback about this form, or about the process of redistributing funds raised through the GoFundMe? (OPTIONAL)

Send me a copy of my responses.