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DocuSign Envelope ID:25B97CDA-7A0C-4ED5-BCD8-9873F30CBE31 <br /> 5.APPLICATION CHECKLIST(in this order;do not staple, bind, or put into individual folders) <br /> One copy:1 sided,81/2"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 /> r' va 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 /> is <br /> artists involved in grant funded activities <br /> ❑ Staff roster all cultural arts teachers in schools with position title(s). <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: Ambra Wilson, New Hope Elementary Principal <br /> A. �r A . _ /�/L 1242016 <br /> Signature of Project Director Date <br /> I <br /> Typed or Printed Name—Authorizing Official: Dr. Lisa Napp, Director of Pre-K, Elementary <br /> Educate 9,)Title I &.III (Orange County Schools) <br /> di, _ 4 ....--- <br /> 12/4/2016 <br /> 'Signature of Autho izing i '� Date <br /> ip <br /> liglir <br /> ii <br /> 919 2A5 2335 1 200 S.Can Street,Hillsborough,NC 27278 I wry w.artsorange.org <br /> r <br />