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DocuSign Envelope ID: 1 FB3C60F-686F-4434-8500-FE7D2516331 E <br /> 5. APPLICATION CHECKLIST (in this order;do not staple, bind, or put into individual folders) <br /> One copy:1 sided,8 1/2"x 11", white paper <br /> ■ <br /> [3vApplication Form, including signatures <br /> L Narrative <br /> Ely Budget Sheet <br /> 113/Itemized Budget(if necessary) <br /> L Resumes of key artists and administrators involved in grant funded program(s) <br /> 123- Organizational Budget for current AND past two fiscal years <br /> E1' Artist contact list, including names,address, phone numbers, and email(if applicable) of all <br /> artists involved in grant funded activities <br /> E'Staff roster of all school art&music teachers with position title(s). <br /> f Board contact list, including names, address, phone numbers,and email (if applicable)of <br /> organization's board of directors <br /> O Copy of IRS Tax Exemption Letter, if private school <br /> E3 Sample programs, press,or other materials from this or similar past programs <br /> ❑ Sample work by artist(labeled with artists' name,title of work, date of work) produced in the (; <br /> last three years: <br /> o Visual artists: CD, DVD,or high resolution photographs(5-10 images). Clearly label each <br /> piece with dimensions and media and indicate top of image <br /> o Dance or theater artist: CD or DVD,or link to high-quality online video (3-5 minutes) <br /> o Music and spoken word: CD, MP3 or link to high-quality online video(3-5 minutes) <br /> o Literary arts: Manuscript(10-15 pages)submitted by.pdf or hard copy <br /> 6. SIGNATURES <br /> i< _Typed or Printed Name—Project Director: /41 S 4e e, 1,6,01e_ <br /> r w�,' f /� o° 4 St/ <br /> Sig ' ture of Project Director Date <br /> Typed or Printed Name—Authorizing Official: \f\ (-----071 A Crrairvi-re- <br /> / <br /> d A i 1 7 ((12 ( i(e <br /> Signature of Authorizing Official Date <br /> Gr: <br /> 919 245 2335 1 200 S.Can Street,Hillsborough,NC 27278 1 www.artsorange.org <br />