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DocuSign Envelope ID:66E45008-FB1D-4049-B8DE-1C00A1D64C3E <br /> PROJECT INCOME Explanation - Cash Income Amount <br /> , <br /> A. Admissions 0-me to public) <br /> B. Contracted Services $0 <br /> Revenue <br /> C. Other Revenue $0 <br /> Corporate Support: $0 <br /> Ii Private Support Foundation Support: S° <br /> Other private support: $0 <br /> Federal: $0 <br /> E. Government Support State/Regional: $0 <br /> Local(not including this request): s(Volunteered) <br /> F. Applicant Cash <br /> G. Grant Amount Requested $3000 <br /> (in this application) <br /> H. Total Cash Income <br /> (must equal Total Cash .$3000 <br /> Expenses, Item G above) <br /> PART 3: APPLICATION CHECKLIST <br /> APPLICATION CHECKLIST <br /> Please compile in this order. Do 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 /> 4Application Form,including signature <br /> 0" Narrative <br /> 1:1-7Detailed Budget(if necessary) <br /> UT Resumes of key artists involved in grant funded program(s) <br /> -El- Sample programs, press,or other materials from this or similar past programs <br /> Letters of support from community partners(if applicable) <br /> GI' 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 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 as.pdf file or hard copy <br /> PART 4: CERTIFICATION <br /> I understand that failure to respond to any of the above items may adversely affect the consideration of this application. I <br /> certify that I am committed to the completion of the proposed project in compliance with legal requirements and granting <br /> procedures. I certify that the information contained in this application, including attachments and supporting materials, is <br /> true and correct. <br /> APPLICANT <br /> Printed or typed name: marie rossettie <br /> Signature: <br /> Date: ,,---- June 1, 2017 <br /> I( I <br />