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DocuSign Envelope ID:F7163211-DB22-463E-994F-9511800DB63B <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 /> [i Application Form,including signatures <br /> El Narrative <br /> 6 Budget Sheet <br /> KA 0 Itemized Budget(if necessary) <br /> Resumes of key artists and administrators involved in grant funded program(s) <br /> 15- Organizational Budget for current AND past two fiscal years <br /> pr Artist contact list, including names,address, phone numbers, and email (if applicable) of all <br /> artists involved in grant funded activities <br /> Ni Staff roster of all school art&music teachers with position title(s). <br /> Pa Board contact list, including names,address, phone numbers,and email(if applicable)of <br /> organization's board of directors <br /> l( Copy of IRS Tax Exemption Letter, if private school <br /> (J 0 Sample programs, press, or other materials from this or similar past programs <br /> O❑ 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 /> b. SIGNATURES <br /> Typed or Printed Name—Project Director: Nancy Zeman <br /> I11-20-2016 <br /> Signature of Prt Direct Date <br /> Typed or Printed Name—Authorizing Official: Lynn Lehmann <br /> 11-20-2016 <br /> Signature of Authorizing Official Date <br /> ( <br /> `'1 y J )0 S or ('.:ry f.I(�l�$bo .i!,3.9€E,.'Ji.. 12%2.; v.,x;✓r .� _?i'�7. :'fe _%(Cy <br />