
Name of Human Service Organization___________________________________________________________
Address of Organization______________________________________________________________________
Phone________________________ TTY____________________	Fax____________________________
Website_________________________________________		Date Survey Completed_______________

Contact Person Name_________________________________ Position _______________________________
Phone __________________________ TTY______________________ Fax ____________________________
E-mail_________________________________________  
Please rate the four major performance genre on a scale of 1-4. 1 being least interested 4 being most interested. Please check the specific(s) types of performances your group would enjoy.
Theatre: _____________		Dance: ___________		Music: ___________
					
Serious Drama___		Ballet__________		Sympony________
	Light Drama_____		Modern________		Folk____________
	Comedy_________		Tap___________		Gospel/Religious____
	Musicals________						Hip Hop/ R&B______
	Opera__________						Jazz/Blues
	Children_________

Visual Arts: ___________	Other: (please comment on other types of performances and/or events your group would enjoy) __________________________
	Exhibits_________			______________________________________________________
	Guided Tours_____			______________________________________________________
	Movie/Video Exhibits____		________________________________________________

Please check the time slot(s) that are best from your group
Days & Times
12:00noon-3:00-pm
4:00pm-8:pm
8:00pm-10:00pm
Monday-Friday



Saturday



Sunday




Comments: ____________________________________________________________________________ __________

How many tickets would your group typically (answer subject to change) need? _______________ 
What kind of accessibility accommodations would your group require? _________________________________
__________________________________________________________________________________________
To keep our databases current and accurate it would be greatly appreciated if you would briefly explain the dynamic of your organization?
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
The mission guiding Boston ARTreach is to help provide the arts for everyone. If you know of a human service organization that works with people with disabilities in or around the Boston area please share so we can help
Name of Organization______________________________________________________________________
Address___________________________________________________________________________________________________________________________________________________________________________
Phone ___________________________________________ Website_________________________________
Contact Person Name_______________________________________________________________________

Thank you very much for taking the time to complete this survey; your insight will be greatly appreciated by the staff and volunteers that work on VSA arts of Massachusetts Boston ARTreach initiative. 
 If you have any further questions or comments please feel free to call 617-350-7713 V, 617-350-6836 TTY.
					Sincerely,
					Colleen Flanagan, Boston ARTreach
