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DocuSign Envelope ID:645F21AA-AAD3-4FC9-BD8D-42EC7135B722 <br /> Artist Project Grant — Spring 2016-17 Application Form <br /> Orange County Arts Commission <br /> Promoting the artistic and cultural development of Orange County, North Carolina <br /> 1 Artist Information <br /> Applicant Name Sheila Kerrigan <br /> Mailing Address 2310 Stansbury Rd. Chapel Hill, NC, 27516 <br /> Daytime Phone 919-360-0690 Fax Number 919-942-4264 <br /> Email Address kerrigan(a mindsprinq.com Web Site www.MimeWhoTalks.com <br /> DUNS Number 08-026-9873 <br /> 2 Grant Request Summary <br /> Arts Program Grant Request $1,000.00 Total Cash Match $1,500.00 <br /> Summary Statement for Proposed Use of Arts Program Grant Orange Co. Senior Centers Residencies <br /> 3 Narrative <br /> Write a description, up to three pages, single spaced, that describes the following under separate <br /> 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, 8 1/2"x 11'; white paper) and 1 complete electronic copy(in PDF <br /> 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'/organizations' name, title of work(s), date of work. For visual arts include <br /> sheet 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(a.orangecountvnc.gov. <br /> 5/30/2016 Sheila Kerrigan <br /> Artist 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.orq <br />