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DocuSign Envelope ID:70E97245-CBDE-4A68-90A8-9FB875F7C092 <br /> / <br /> MrelintreiteptrifffrperrIONIIIMMVIIIEMpriapprirliirrorlIORIIrplIkIMIIIIIIIMMIPplrrplNIIIIIIIIIII',',,l,l7N:liv„mr,d,pipsvae,°'6111 <br /> Monthly weaving work-. ops (12 mo. X $100.00) est. <br /> PART 1. 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 /> O Application Form, including signature <br /> O Narrative <br /> O Detailed Budget (if necessary) <br /> [] Resumes of key artists involved in grant funded program(s) <br /> [] Sample prmgrame, pn*oa, or other materials from this or similar past programs <br /> O Letters of support from community partners (if applicable) <br /> O Work samples byartiat(s) labeled with a�isto' name, Ut|eofvvork. date ofvvorh. produced in the last three years: <br /> o Visual artists: ` DVD, or high resolution photographs (8 images per artist MAX), clearly labeled with <br /> dimensions and media and indicate top of image <br /> u 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 /> Printed or typed name: Dawn Hummer <br /> �—/ 7 �l / �/�/ it-- <br /> �7 / ~-- / ~- - / <br /> Date: May 22, 2017 <br /> 5 <br /> 20l7 Grassroots Pmgmm Grant Application pocket <br />