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DocuSign Envelope ID: 3F12CD86-8239-4E1 E-BCE6-2327E57AF832 <br /> I Artist Project Grant - Spring <br /> \ --N/ <br /> e 2016-17 Application Form <br /> ORANGE COUNTY ARTS Orange County Arts Commission <br /> COMMISSION <br /> Promoting the artistic and cultural development of Orange County, North Carolina <br /> 1 Artist Information <br /> Applicant Name iettvw, e <br /> Mailing Address L ` .. C cadet rict e, Dux V-vawi NC 2,17 QS- <br /> Daytime Phone Fax Number <br /> Email Address I 02 at ark; IWeb Site c a s ikhki:fad '- '( <br /> DUNS Number <br /> 2 Grant Request Summary <br /> Arts Program Grant Request 6 1 00 UQ Total Cash Match 2000 'gym <br /> L(.;V i c ( - t. ' > '3 <br /> Summary Statement for Proposed Use of Arts Program Grant �� <br /> 60,1 e f _> ti) (1-V4-AAA L. € <br /> 3 Narrative � � � �` t� tit t {k � t�/�C�CL(E�'� �'�� <br /> Tea( t tikk 'f`P (L t �/iVti t? ..__ ' ,t,tyt <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 /> 4 Application Checklist (in this order;do not staple, bind, or put into individual folders) <br /> 1 copy each: (only 1 sided,81/2"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 images); <br /> for dance or theater arts submit a PC-compatible CD or DVD,or video tape(3-5 minute sample);for music and <br /> spoken word submit a PC-compatible CD or DVD,or audio tape(1-2 selections);for literary arts submit a <br /> manuscript(10-15 pages). <br /> Label all sample work with artists'/organizations' name,title of work(s),date of work. For visual arts include sheet <br /> with work dimensions, media. Indicate top of image. <br /> Mail or deliver signed original to the OCAC office,including work samples. Email PDF of application to <br /> arts @orangecountyjnc.gov. <br /> '(?: - leifik' ie a 14 t3rt)4 e>tet- 'I'm- <br /> rtist Signature Date Typed or Printed Artist Name <br /> INCOMPLETE APPLICATIONS WILL NOT BE FUNDED <br /> 919/968-2011 - 131 West Margaret Lane, Room 216, Hillsborough, NC 27278-www.artsorange.org <br /> )11„, <br />