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DocuSign Envelope ID:66651854-9741-4A24-AE80-28409E6F98EA <br /> PART 3: APPLICATION CHECKLIST <br /> APPLICATION CHECKLIST <br /> Please cornplie in this order. Do net staple, bind, or put into individual folders or sleeves,. Provide one copy, <br /> one sided, &5 x 11 white paper., A digital copy of the application is not necessary, <br /> O Application Form, including signatures <br /> O Narrative <br /> O Detailed Budget(if necessary) <br /> O Resumes of key artists and administrators involved in grant funded prograrn(s) <br /> O Income and Expense statement for FY15-10 <br /> O Budget or year-to-date statement for FY16-17 <br /> O Budget for FY17-15 <br /> O Current :oard of Directors list <br /> O Copy of IRS Tax Exemption Letter, if applicable <br /> O Sample programs, press, or other materials from this or similar past programs <br /> O 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(S images per artist MAX), clearly labeled with <br /> dimensions and media and indicate top of image <br /> Dance or theater artist: CD or DVD, or link to high-quality online video(3-5 minutes <br /> c„) Music and spoken word: CD , 1MP3 or link to high-quality online video(3-5 minutes) <br /> o Literary arts. Manuscript(10-15 pages) submitted as „pdf file or herd 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 procedures. We certify that the information contained in this application, including attachments and supporting, <br /> materials, is true and correct to the best of our knowledge. <br /> PROJECT DIRECTOR(if applicabill <br /> Printed or typed name: Sarah Baron <br /> Signature: <br /> tett/ <br /> Date: 5/10/2017 <br /> ALITHORI 4 WI OFFICIAL(required) <br /> Printed or typed name p <br /> arn as, <br /> „ 47 <br /> / <br /> Signature: -4/ "' <br /> Date: 5/10/2017 <br /> C,onr,ArrIli%ririruL,1(11 ri 7.4t,,r4 AWlinn Kir Pnrki,..q <br />