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DocuSign Envelope ID: 59E57F53-A0B6-4CC1-AF71-8317BFA38938
<br /> PART 3: APPLICATION CHECKLIST
<br /> APPLICATION CHECKLIST
<br /> Please compile In this order. rito not staple, bind, or put into individual folders or sleeves. Provide one copy,
<br /> one sided, 8.5 x 11 white paper. A digital copy of the application is not necessary,
<br /> Application Form, including signatures
<br /> I37' ' ' ' ' '' .
<br /> Narrative
<br /> Detailed zudget(if necessary)
<br /> Resumes of key artists and administrators involved in grant funded program(s)
<br /> income and Expense statement for FY15-16
<br /> E Budget or year-to-date statement for FY16-17
<br /> re, Budget for FY11.18
<br /> L Current Board of Directors' list
<br /> I1 Copy of IRS Tax Exemption Letter, if applicable
<br /> i' sample programs, press, or other materials from this or similar past programs
<br /> / Work samples by artist(s), labeled with artists'name, title of work, date of work, produced in the last three years:
<br /> O Visual artists:CD, DVD,or high resolution photographs(8 images per artist MAX), clearly labeled with
<br /> dimensions and media and indicate top cif imag;
<br /> O Dance or theater artist:CD or D'VID, or link to high-quality online video(3-5 minutes)
<br /> o Music and spoken word:CD , MPA or link to high-quality online video (3-5 minutes)
<br /> o Literary arts: Manuscript(10-15 pages)submitted as ,pdf file or hard copy
<br /> PART 4: CERTIFICATION
<br /> We understand that failure to respond to any of the above items may adversely affect the consideration of this application.
<br /> We certify that we are committed to the completion of the proposed project in compliance with legal requirements and
<br /> granting prosedurea We certify that the intomiation contained in this application, including attachments and supporting
<br /> materials, is true and correct to the host of our knowledge.
<br /> lal.,071■1.11M11 X.///0011,11.4111111M1M111.1.01111 L.' ,
<br /> PROJECT'DIRECTOR(If appl Icabfe) I
<br /> Printed or typed name: Camille Witt
<br /> Signature:
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<br /> Date: 1 5 3 1 1-7
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<br /> AUTHORIZING OFFICIAL(required) :
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<br /> Signature:
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