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DocuSign Envelope ID: 7E107417-F9E7-4B2F-A30A-B4D250909DD9
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<br /> APPLICATION CHECKLIST
<br /> Please c;oi.npit(9 in this order Do dot stettp4o, bir,i(1,, or pmt into 69clivictlial felelers or„sleeves., Provicle or w copy,
<br /> one sided, 8,5 x 11 white paper A digital copy of thi,,,, applicalioe is stlutli,neoessarty,
<br /> P1/‘ Application Forn-r, inoliiiding signatures
<br /> Narrative
<br /> 0 Detailed Buctget It It 055 ssa ry)
<br /> rae Re'21,1510 5 of key artists,and addlinierrators iinvolved in grant funded program(s)
<br /> tki Irloont e '..1.,11 d tExr,terrise statement for r Y15.16
<br /> IF:yr: Fitter:jot or yeer-te-date stsitement for IV16-1 7
<br /> FA" Budget for 1,,,(1'7-18
<br /> 10' Current Heard of DI-actors list
<br /> L1f,Copy of IRS Tax Exemption I....e tier, if rtipplicable
<br /> 1,7R',,Sample prograrn 5, press., rif other rriaterittris frodi this or similar past orograrris
<br /> iluir Work samples by itirritir(e) labeled with artists' name, title of work, date of work, produced in the last three years
<br /> it Visual earners CD, DVD, or high restAlittion ohologr-apIns,(El ima,ges per artist MAX), clearly labeled with
<br /> dirriensioris and media and inchoate top of image
<br /> Danre olitilleater artist, CD 0 r EitVD, cor Itillk to It:grit-quality online video (3-5 mit-rules)
<br /> M US ie and spoken word, C,,L, MP3 or link to high-quality online video (3-5 mintitesa
<br /> Literary arts: IMitiiniiscript (1 ),1 5 pages) submitted as ,pd,f file or loud copy
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<br /> We ttriderstarid that failure to respond to any at the„ailDiova items may adversely affect the consideration of this
<br /> We certify that wr are carom itteh'i,o the completion of the proposed project in compliance um illoiti
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<br /> granting orodacirriros We ceitify that the information contained in trhs noplication, inoltidingvv4:131tthachligrrailernetls'il
<br /> niarerialls, is true end (xtrrect to the bent of OH knowledge. IN:„!:,„1111,1,1,1,1,11,111,11,1„„„,MIIIII0111111111111,111,111,111,1„„„„„
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<br /> Rm'OJECL^u!, DIRECTCfR,(it urmperichble)
<br /> Printod or typed name:, Sue T. Klausmever, DMA
<br /> Lel irnedniseun:::111:;,,D;:lii,Ilii.:11;inciiiiigtion
<br /> Signature: tt - i ' ) A 1181,
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<br /> AUTFIORIZ1 tCttt OFF CAEtt,(required)
<br /> Printed or typed name, Susan H Brunssen, PhD
<br /> Signature:
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<br /> Date;
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