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DocuSign Envelope ID: EC417424-B3E6-4014-A465-9859A57DDD04 <br /> • Proposed uses of grant funds—description, including location,date,artists involved. Include <br /> information concerning whether you have undertaken similar activities in the past. Include <br /> approximate number of audience per program;geography of audience; mix of race,ethnicity, <br /> age,and gender. Discuss how arts program will be integrated into the curriculum. <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 /> WSJ, tl is Budget Sheet <br /> ;yvii_t„ ❑ 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 /> j/ artists involved in grant funded activities <br /> ❑ Staff roster of all school art&music teachers with position title(s). <br /> El 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 /> (f 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 /> eCtt 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: Tracy Thomas,Cultural Explosion Committee Co-Chair <br /> �1 12/4/2016 <br /> Signature of P oject Director Date <br /> Typed or Printed Name—Authorizing Official: Heather Blackmon,Cedar Ridge Principal <br /> 12/4/2016 <br /> Signature of Authorizing Official Date <br /> 9 19 24F:'2, 5 I 200 %tr:.;_.t !-IJI;..r ...lqi'.1"...27278 I J'a°,orii... ;i'.l - J.9 <br />