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DocuSign Envelope ID: 16527E62-848E-428A-BF83-02D57E8435C9 <br /> 5. APPLICATION CHECKLIST (in this order;do not staple, bind,or put into individual folders) <br /> One copy:1 sided,81/2"x11", white paper <br /> ❑ Application Form, including signatures <br /> ❑ Narrative <br /> ❑ Budget Sheet <br /> ❑ Itemized Budget(if necessary) <br /> ❑ Resumes of key artists and administrators involved in grant funded program(s) <br /> ❑ Organizational Budget for current AND past two fiscal years <br /> ❑ Artist contact list, including names, address, phone numbers,and email (if applicable)of all <br /> artists involved in grant funded activities <br /> ❑ Staff roster of all school art&music teachers with position title(s). <br /> ❑ Board contact list, including names,address, phone numbers,and email (if applicable)of <br /> organization's board of directors <br /> ❑ Copy of IRS Tax Exemption Letter, if private school <br /> ❑ 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 /> Typed or Printed Name-Project Director: Cri qrt(tt Sot è-z _ <br /> Signature of Project Director Date <br /> Typed or Printed Name-Authorizing Official: -ZA h-9'\ (4kls <br /> 1 fr vi9 t2-9 I i <br /> Signature of Autho 9 g Official Date <br /> 919.245.2335 1 200 S.Cameron Street,Hillsborough, NC 27278 1 www,artsorange.org <br />