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DocuSign Envelope ID: DCA5DA42-63ED-423C-B54F-BA5787EE2991 <br /> 5.APPLICATION CHECKLIST(in this order;do not staple,bind, or put into individual folders) <br /> One copy:1 sided,8112"x 11'; 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 /> ,,,Q—Organizational Budget for current AND past two fiscal years <br /> j ❑ Artist contact list,including names,address, phone numbers,and email (if applicable)of all <br /> ` — artists involved in rant funded activities <br /> ar I g <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 /> �C) 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 e Project Director: Wayne Wilson Pathways Music Teacher <br /> 1, <br /> � i tj, r <br /> 12/4/2016 <br /> Signature�lof Project Director Date <br /> i <br /> Typed or Printed Name o Authorizing Official: Patricia Harris Orange County Schools' Director of <br /> College and Career Readiness CTE Guidance <br /> i <br /> i <br /> 12/4/2016 <br /> Signature of Authorizing Official Date <br /> 1S.2A5. :;:= I 0`l S <5nu:ror 5tr^C-;i. {ItIIS oi-o1,lt,Pl( `<'.l:'7i; ;yb1rN:'C�(fSo(C7(tryi'( i,l <br />