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DocuSign Envelope ID: D9AFB279-4BB8-4BEO-B6B5-342497BC18DB <br /> '14t°1■01161F <br /> Plitt <br /> 201718 <br /> ARTS GRASSROOTS ARTS PROGrAM <br /> ORANGE COUNTY <br /> commlsslott www„nca rts.org APPLICATION FORM <br /> „ <br /> PART I APPLICATION OR,OANIZ,A,TIO,N INFORMATION c <br /> Organization Name: ille° :01 prit <br /> JJLt <br /> Street AdriressL,3_5iiiiliiiii,LLIcliiiiivizaj <br /> ,111. <br /> City: <br /> , State,: Ltii3O' , <br /> Phone: e :x.c1 Ntifebsite: c 411 e. <br /> Authorizing Official Name: <br /> Authorizing Official Tale: <br /> .Authorizing Official Phone: t g, „, 2,5 ,Authorizing Official Email: eiriiilt:/krililirieiikiii'vrt,idetihtili <br /> Applicant Race: Organization EIN: - <br /> 0 GANIZATIONAL FINANCES <br /> Please attach a complete ncome and expense statement(an audit may be substituted)for your last fiscal year and <br /> complete operating budgets for the current fiscal year and next fiscal y par. Public schools and other large governmental or <br /> community agencies should attach arts program tiniarir;101 information only. Please,copy the totals from these attachments <br /> in the spaces blow: <br /> LtYrAwil: FY"16.16 Current Yer FYI r-17 Next Yer: FY1718 <br /> Actual Income: $ 0 „ 0 6 Projected Income: $ ,57 9 63 s," I Projected income: $ 0, <br /> Actual Expenses: $ o g° Projected Expense: $ „ Projected Expense,: <br /> PART 2 PROJECT INFORMATION <br /> PROJECT DIRECTOR 1NF0RNIATION if different from Aiothoriziril <br /> Project Director Nsrni Ii _10, <br /> Project Director :': ;1: Is r,,E,,w -41 <br /> Street,Address: <br /> City - t <br /> Phone: - V c'''L Email: d C0,41 <br /> PROJECT SUVINIARY <br /> „ ; <br /> Title of(want Program of Project Aid - 1_4,117 " — <br /> (742 FiLeki ' Litfic <br /> Grant Amount Requested: qe" 2.5 <br /> In <br /> Project Start Date (No earlier than Jul y 1, 2017): <br /> Project End Date (No later than jape 30, <br /> SCHOOLS ONLY: <br /> Are you booking your artists through The ArtsDenters Arts Schools Program? 1134./;;;S 0 NO <br />