* Required Fields
* Name of Organization:
* Type of Organization:
Independent living housing
Housing with services
Home care services
Adult day services
Residential care homes
Assisted living
Nursing care
Hospice
Hospital
Other
* Contact First Name:
* Contact Last Name:
* Title:
* Address:
* City:
* Region: What's this?
Please Select
Outside Minnesota
STATEWIDE
METRO AREA
SOUTHWEST
SOUTHEAST
CENTRAL
WEST CENTRAL
NORTHEAST
NORTHWEST
* State/Province:
Other - Not listed
AB - Alberta
AL - Alabama
AK - Alaska
AR - Arkansas
AZ - Arizona
BC - British Columbia
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
MB - Manitoba
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NB - New Brunswick
NC - North Carolina
ND - North Dakota
NE - Nebraska
NF - Newfoundland
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NS - Nova Scotia
NT - Northwest Territories
NU - Nunavut
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
ON - Ontario
OR - Oregon
PA - Pennsylvania
PE - Prince Edward Island
PR - Puerto Rico
QC - Quebec
RI - Rhode Island
SC - South Carolina
SD - South Dakota
SK - Saskatchewan
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
YT - Yukon
* Zip/Postal Code:
* Country:
* E-mail:
Phone (w Area Code):
Fax (w Area Code):
Website:
Social Network URLs:
(for example: Facebook, YouTube, MySpace, Twitter, 2nd Life, Flickr, LinkedIn, etc)
* Provide a basic description of your organization and its services.
* Describe any ongoing or frequent arts-related programs offered through your organization.
* Describe specific spaces, equipment, or supplies you have to accommodate artistic activities.
Other important information you want to include:
* Types of artists wanted (painters, writers, dancers, etc.) that you would like to have teach/perform/present for your organization.
Please send 1-4 photos showing artistic activities your clientele participate in or photos of available space and resources for such activities. Photo 1 should be the main image you want displayed. After submitting this form you will be given an email address to send your images.
Format specifications: JPG, preferably no bigger than 600 x 600 pixels, 72 ppi resolution. Image files should not be larger than 5 MB.
MnCAAN will screen the above information for relevance to our website visitors and may contact you for further information.
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