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DocuSign Envelope ID: 124C6798-3E02-41 F0-AOB2-48070A27BF55 <br /> fbc:‘, <br /> I l/ Artist Project Grant Fall <br /> 2015-16 Application Form <br /> ORANGE COUNTY ARTS Orange County Arts Commission <br /> COMM ISSION <br /> Promoting the artistic and cultural development of Orange County, North Carolina <br /> 1 Artist Information <br /> Applicant Name Michael Roy Layne dba Legacyworks <br /> Mailing Address 442 S. Main St.,Warrenton, NC 27589 Studio: 135 S. Main St.Warrenton, NC 27589 <br /> Daytime Phone 919.616.8427 . Fax Number 252,257.0655 <br /> Email Address layne @legacyworks.com Web Site Legacyworks.com <br /> DUNS Number 078634526 _ <br /> 2 Grant Request Summary <br /> Arts Program Grant Request $1,000 Total Cash Match $3,577.50 <br /> Summary Statement for Proposed Use of Arts Program Grant Artist fee for creation of a pair of ferro-cement <br /> and fabric seed pod forms IVasilas de Agualluviay as part of a larger rainwater harvesting system and science <br /> and arts oriented{STEAM]outdoor classroom environmental sculpture[Cana Proeec#)of courtyard at St. <br /> Thomas More School in Chapel Hill. <br /> 4 Narrative <br /> Write a description,up to three pages,single spaced,that describes the following under separate subheadings: <br /> • Proposed Project—what will you do,where will it be performed or displayed,when will the preparations <br /> and public component take place, list any organizational partners. <br /> • Community Impact—describe the project's public component, how many people will be impacted. <br /> • Artist Experience—include a brief description of your similar arts projects in the past. <br /> 5 Application Checklist(in this order; do not staple, bind, or put into individual folders) <br /> 1 copy each: (1 sided,8 112"x 11", white paper)and 1 complete electronic copy(in PDF format) <br /> • Application Form, Page One, Including Signature <br /> • Narrative <br /> • Budget Sheet <br /> • Itemized Budget(if necessary) <br /> • Resumes of artist(s) <br /> • Sample programs, press, or other materials from this or similar past programs <br /> • Sample work by artist produced in the last three years: <br /> For example,for visual arts submit a PC-compatible CD or DVD, slides or high quality photographs(5-10 <br /> images);for dance or theater arts submit a PC-compatible CD or DVD,or video tape(3-5 minute sample);for <br /> music and spoken word submit a PC-compatible CD or DVD,or audio tape(1-2 selections);for literary arts <br /> submit a manuscript(10-15 pages). <br /> Label all sample work with artists'lorganizations'name,title of work(s),date of work. For visual arts include <br /> sheet with work dimensio , -,la. ndioate top of image. <br /> Mail o '1> lve. 4.! ed original.to the OCAC office, including work samples. Email 1 PDF of completed <br /> a,.•:l ion •:47,0, • ':etountync.gov. <br /> ����1f,[:�I 1 11/30/15 Michael Roy Layne <br /> 4 irr- re Date Typed or Printed Artist Name <br /> i <br />