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DocuSign Envelope ID:ACA23e47-0485-420A-873e-7C5oA8o47o00 <br /> 1 Ii, Arf'~f Proj~rf Grant _ ~r r'ng <br /> ��� 1 ��-1 ~7 Application Form <br /> � �� ~-� � � � ' ' `rr~''-~~~^~ ' � <br /> �~�r ' <br /> Orange County Arts Commission <br /> ORANGE COUNTY ARTS <br /> - - ~^ - - - / - <br /> mwmouo^ <br /> Promoting the artistic and cultural development of Orange County, North Carolina <br /> 1 Artist Information <br /> Applicant Name ��z "� �7�, i\V L�*� �u1 A . \ > <br /> ���� � . � J� � <br /> Mailing Address ��,- �- �c�� �~��� �7/�—^ p��~ ����� / / <br /> Daytime Phone ��/xy- 6e�6 ~/���7z Fax| umber' -------- <br /> � � � /�} _----- <br /> Emai|Addreoa�� ..����y���� =' Web Site <br /> ��- a/'/^000�U�SNum�er �-� ����/ �-�� � ------ <br /> _ / '^ ~ - . . � <br /> 2 Grant Request Summary, <br /> Arts Program Grant Request Total Cash Match :50��) <br /> Summary Statement for Propos Use of Arts Program Grant 42-7/5-7/u_ p ER&- L_—__ <br /> 3 Narrative <br /> Write a description, up to three pagou, single spaced,that describes the following under separate subheadings: <br /> • PmpoaodPrnjec\—whatwi||youdo^wherewi||itbeperformodordiup|ayed. whonwiUthepnaparnUiono <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, 8 1/2"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 pmgmma, pnaao,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 /> apokenwondoubmitaPC'compn0ib|oCDorDVD. oroudiotape (1'2ae|eu1iona);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 sions, media. Indicate top of image <br /> M o deli e signed original to the OC C office, including work samples. Email PDF of application to <br /> , . �~ *-� '° d^�� °�� / 1 `Al /�~v`-��`-/ <br /> 1'44 <br /> A�i ~� 'a1une Da�+ �vp�� ur Print�d Artiat Name <br /> INCOMPLETE APPLICATIONS WILL NOT BE FUNDED <br /> 91 / SB`2011 ' 1J1N/eat Margaret Lane, Room 216, Hillsborough, NC 27278—www.artsorange.org <br />