Application for Arts Mentoring

APPLICATION FOR ARTS MENTORING

The Prison Arts Foundation is Northern Ireland’s only prison arts charity. We have for the last

20 years been in the unique position to ‘champion the arts’ within Northern Ireland’s criminal justice system.

Our aim is to release the creative potential of those serving custodial and community sentences, and those at risk of re-offending by engaging professional artists to teach, enthuse and give inspiration through writing, drama, visual art, craft and music.

Our vision is of a criminal justice system where PAF’s work is valued by all its stakeholders, is seen as crucial to the rehabilitation process and everyone has the opportunity to positively channel their creative energies and talents through the arts.

Through our two different mentoring opportunities, we offer support to people who want to develop their arts-based activities and skills by having one-to-one mentoring sessions with a Mentor.

PAF’s Mentors are trained artists, writers and musicians who volunteer to support people who have been involved in the criminal justice system and who would like to develop their arts interests.

If you would like to receive support from one of our mentors, please fill out this application form with as much detail about you and your arts interests as possible. You can also attach additional information to this form as it will really help us in finding you a suitable mentor – for example you could send examples/photocopies of your work, or include a letter or supporting statement from an arts tutor, teacher or writer in residence.

Please note, that a failure to disclose relevant information such as previous convictions may mean that we are unable to consider your application.

Once we have received your application, we will seek a reference to support your participation in the mentoring scheme and there is space on the form for you to give us details of who we should contact. If you are still in prison, or are on licence in the community, please give details of a Probation Officer, Offender Manager or Key Worker. If you are no longer being supervised by a criminal justice agency, please give the contact details of a relevant professional who can support your application.

Please be aware that we are only able to work with a limited number of individuals. Unfortunately

PAF cannot guarantee that a mentor will be found for every applicant.

If you have any queries or concerns regarding the completion of this application form please contact a member of the PAF team on 02890 247872.

Please return completed application forms to:

Confidential Arts Mentoring

PRISON ARTS FOUNDATION

Unit 3 Clanmil Arts & Business Centre

3-10 Bridge Street

Belfast

BT11LU

REMEMBER – You must let us know if your contact details change after you have submitted this application.

ARTS MENTORING APPLICATION FORM

PRIVATE & CONFIDENTIAL

SURNAME / FORENAME
PRISON / PRISON NUMBER
DATE OF BIRTH / / / AGE
PLEASE STATE YOUR MAIN AREA OF ARTS INTEREST e.g. fine arts, drawing, sculpture, poetry etc.
Please indicate, by ticking the appropriate box, which other art form(s) you work in or wish to develop:
5 Calligraphy / 5 Music / 5 Pottery
5 Card/Poster design / 5 Murals / 5 Prose – Fiction & Non Fiction
5 Craft / 5 Needlecraft / 5 Sculpture
5 Drawing / 5 Oil, tempera & acrylic painting / 5 Tattooing
5 Fashion & Beauty / 5 Pastels / 5 Textile Art
5 Furniture / 5 Photography / 5 Watercolour/gouache painting
5 Graphic Design / 5 Playwriting for radio/stage / 5 Woodcraft
5 Magazine Design / 5 Poetry / 5 Writing for television
5 Other please specify -
AWARD SUCCESS
Have you ever won a Koestler or Listowel Award? YES 5 NO5
If ‘Yes’ please give details e.g. name of prize, year, what prize was for:
Have you ever had work exhibited at a Koestler exhibition or published? YES 5 NO5
If ‘Yes’ please give details:
HELP REQUIRED
Please tell us what help you would like from your Arts Mentor:
Finding out about exhibitions and events / Developing your Technique
Accessing resources in your local community / Exhibiting/Disseminating your work
Building an arts related support network / Building your self-esteem and confidence
Applying to further education / Promoting your work
Finding out about training courses / Developing wider hobbies and interests
Building a Portfolio of work / Making constructive use of leisure time
Funding opportunities / Setting goals for yourself
Anything else?
Please answer the following questions in as much detail as possible as it will help us determine whether we have a suitable mentor available to work with you.
What activities or training courses are you currently involved with?
Are there any courses or activities that you would like to take part in but are not able to do at the moment?
What are your interests outside of art (e.g. sport, film)?
What do you think you would like to do in the future?
Is there any other information you think we should know, or would like to tell us?
We encourage mentee applicants to send examples of their work with their application – photocopies or photographs are fine.
Have any additional documents been attached to this application? YES 5 NO5
If YES please give details
RESETTLEMENT AREA / If known, or you are living in the community:-
Where do you plan to live on release?
……………………………………………………………..
PLEASE LET US KNOW IMMEDIATELY IF ANY OF THESE DETAILS CHANGE / ADDRESS
POSTCODE

RELEASE DATE (or anticipated month of release)

/ DATE OF CONVICTION / LENGTH OF SENTENCE
CURRENT OFFENCE(S) / PREVIOUS CONVICTIONS
PAF WILL NEED TO GET A REFERENCE SUPPORTING YOUR APPLICATION BEFORE WE CAN ALLOCATE A MENTOR.
By filling out this form you give consent for Prison Arts Foundation to speak with the person named below about your involvement in the scheme. A copy of this form will also be sent to them for their records. If you are currently supervised by Probation/Criminal Justice Agency, please give these contact details, otherwise a suitable relevant professional.
NAME
…………………………………………………………………. / ADDRESS
POSTCODE
RELATIONSHIP TO YOU
………………………………………………………………….
TELEPHONE NUMBER
………………………………………………………………….
EMAIL ADDRESS
………………………………………………………………….

MONITORING FOR DIVERSITY

Community Background:

Regardless of whether they actually practice a particular religion, most people in Northern Ireland are perceived to be members of either the Protestant or Roman Catholic communities.

Please indicate the community to which you belong by ticking the appropriate box below:

I am a member of the Protestant community:

I am a member of the Roman Catholic community:

I am not a member of either the Protestant or the

Roman Catholic communities:

Sex:

Please indicate your sex by ticking the appropriate box below:

Male:

Female:

Racial Group:

Please state your country of birth:

My country of birth is: ______

Please state your nationality:

My nationality is: ______

Please indicate which of the following applies to you:

White Chinese

Irish Traveller Indian

Pakistani Bangladeshi

Black Caribbean Black African

Black Other

Mixed ethnic group (please state which): ______

Any other ethnic group (please state which): ______

Language:

Is English your first language?

Yes No

Disability:

Under the Disability Discrimination Act 1995 you are deemed to be a disabled person if you have cancer, multiple sclerosis or HIV infection.

Also, you are deemed to be a disabled person if you have a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities.

Do you consider that you are a disabled person?

Yes: No:

If you answered “yes”, please indicate the nature of your impairment by ticking the appropriate box or boxes below:

Physical impairment, such as difficulty using

your arms, or mobility issues requiring you to use

a wheelchair or crutches:

Sensory impairment, such as being blind or

having a serious visual impairment, or being deaf

or having a serious hearing impairment:

Mental health condition, such as depression

or schizophrenia:

Learning disability or difficulty, such as

Down’s Syndrome or dyslexia, or Cognitive impairment,

such as autistic spectrum disorder:

Long-standing or progressive illness or health condition,

such as cancer, HIV infection, diabetes, epilepsy or

chronic heart disease:

Other (please specify):

………………………………………………………………………

Sexual Orientation:

Please indicate your sexual orientation by ticking the appropriate box below:

My Sexual Orientation is:

I am straight:

I am gay or lesbian:

I am bisexual:

Marital Status / Civil Partnership Status:

Please indicate whether you are married or in a civil partnership by ticking the appropriate box below:

Are you married or in a civil partnership?

Yes: No:

Dependants / Caring Responsibilities:

Do you have dependants, or caring responsibilities for family members or other persons?

Yes: No:

If you answered “yes”, are your dependants or the people your look after?

(Please tick the appropriate box or boxes):

A child or children:

A disabled person or persons:

An elderly person or persons:

Other:

If “Other”, please specify: ______

I CONFIRM THAT THE INFORMATION ON THIS FORM MAY BE SHARED WITH MY MENTOR AND A COPY SENT TO MY REFEREE.
SIGNATURE
DATE

Please return to:

Confidential Arts Mentoring,

The Prison Arts Foundation,

Unit 3 Clanmil Arts & Business Centre,

2-10 Bridge Street,

Belfast, BT11LU