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DocuSign Envelope ID:06711178-0E3F-4541-A834-A91 FC422F4D1 <br /> APPLICATION CHECKLIST (in this order;do not staple,bind, or put into individual folders) <br /> One co •1 sided,81/2"x 11", white paper <br /> Vpplication Form, including signatures <br /> rrative �= <br /> Budget Sheet <br /> ❑ Itemized Budget(if necessary) <br /> rW11 sumes of key artists and administrators involved in grant funded program(s) <br /> ganizational Budget for current AND past two fiscal years <br /> rtist contact list, including names, address, phone numbers, and email (if applicable)of a <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) ci <br /> organization's board of directors <br /> 1:1_,C.opy of IRS Tax Exemption Letter, if private school <br /> iii 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 /> 5. SIGNATURES <br /> Typed or Printed Name—Project Director: Lynn Weller <br /> (VePan <br /> —5 gnature of Project Director Date <br /> Typed or Printed Name—Authorizing Official: ono <br /> Via©� 1 <br /> S.'•ture of Authorizing Official Date <br /> ■ <br /> ICI <br /> 919.245.2335 1 200 S.Cameron Street, Hillsborough,NC 27278 I www.artsorange.org <br />