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DocuSign Envelope ID:AA4o52F4-E4o6-4Fo4-9e10-E18606475c71 <br /> A. Admissions <br /> B. Contracted Services <br /> Revenue <br /> C. Other Revenue � <br /> Corporate Support: $ 4�(��� <br /> � <br /> O. Private Support Foundation Support: � <br /> Other private support: � <br /> Federal: � <br /> E. Government Support State/Regional: � <br /> Local(not including this request): � <br /> F. Applicant Cash � <br /> G. Grant Amount Requested $ ��,��� <br /> �n��e��abo� � �'��, <br /> H. Total Cash Income <br /> (must equal Total Cash $M ,C;���1 <br /> Expenses, 8omG�wm� 11 - � � <br /> PART 3: APPLICATION CHECKLIST <br /> ^ ^ ^^ ^ ^ -^ ^ ~~ ~ ^�`-` `` --`- -` `--` --`- ` <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 /> Er Application Form, including signature <br /> Er Narrative <br /> O Detailed Budget(if necessary) <br /> O Resumes of key artists involved in grant funded program(s) <br /> Et# Sample pnognamo, pneee,or other materials from this or similar past programs <br /> El' Letters of support from community partners(if applicable) <br /> Et° 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. | <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 opp|ioaUun, including attachments and supporting mabaria|e, is <br /> true and correct. <br /> APPLICANT <br /> Printed or typed name: Jenks Miller <br /> Signature: <br /> , ��� �� <br /> D�* 5-11� � � ^� K � <br />