1. BASIC INFORMATION Your name: Your role: Your email address: Your telephone number: 2nd contact name & number: Organisation you work for: Address of organisation where workshops would be held: • Please tell us about the potential participants: • How many, approx.? ___ • Average age? ____ • Gender? _______ • Interests/abilities in art (as far as you are aware)? • How do you think they would benefit from art workshops? We run trial series of to gauge their success/popularity, before embarking on any longer programmes. If your trial series were successful/popular, might you be interested in a longer series of workshops? Y/N If Yes, is your organisation in the position to provide funding/fundraise for these with our support? QUESTIONNAIRE FOR MANAGERS How did you hear about us? • Could you support us with the following? • Ensure a staff member is present at each workshop? Y/N • Find a communal space at your organisation with tables and chairs where workshops could take place? Y/N • Help with evaluation forms at the end of the workshop series? Y/N • Act as lead contact for any general queries throughout? Y/N Any other comments? Please return to Amelia Calvert, Outreach Manager at outreachmanager@artinhealthcare.org.uk