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DocuSign Envelope ID:56A5C00E-0F80-4BDF-A1A7-5530F0DB9396 l <br /> l <br /> C A 19.,.., <br /> z -0 <br /> 00 201718 <br /> ,c7:7 <br /> ORANGE COUNTY ARTS co GRASSROOTS ARTS PROGRAM <br /> COMMISSION www.ncarts.org APPLICATION FORM <br /> PART 1 : APPLICATION ORGANIZATION INFORMATION <br /> Organization Name:KT(52u Children's Museum <br /> Street Address:0Yr S7Esre"CCYrl\re; Sre-Vg <br /> --CitTCT:faPeTRir— State:NG Tzia:27516 <br /> Phone:919.933.1455 Website:www. litiFzuebirffensmuseum.org <br /> Authorizing Official Name:LisaVAT) EYeman <br /> Authorizing Official Title:"E"XeCatrve'DiTe do r <br /> Authorizing Official Phone:919.g331-455 1 Authorizing Official Email:var-TdeTtra–n-gRrarjeiTiareTir <br /> Applicant Race:ralCaslon Or EIN: <br /> ORGANIZATIONAL FINANCES <br /> Please attach a complete income 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 year Public schools and other large governmental or <br /> community agencies should attach arts program financial information only Please copy the totals from these attachments <br /> in the spaces below: <br /> 1 <br /> Last Year Actual: FY15-16 Current Year: FY16-17 Next Year: FY17-18 <br /> Actual income: $ , Projected Income:054;606 Projected Income: <br /> • <br /> Actual Expenses: $9237755 Projected Expense: $ , Projected Expense: $990,261 <br /> 1 <br /> PART 2: PROJECT INFORMATION <br /> PROJECT DIRECTOR INFORMATION if different from Authorizing Official) <br /> Project Director Name: Y e arlie-FaT2-Levinson <br /> Project Director Title Creative Director <br /> _ <br /> Street Address:We eheve <br /> City: State: Zip: <br /> Phone:grg.g3TT455— Emii;TeVirlson • uozucTilidfensmuseum.org <br /> PROJECT SUMMARY <br /> Title of Grant Program or Project:: <br /> Cu rating CreatiVIty <br /> Grant Amount Requested S3,000 Project Start Date (No earlier than July 1, 2017): " ugu§fIC2017 <br /> Project End Date (No later than June 30, 2018):Jlirie30, 20 ; 1 <br /> SCHOOLS ONLY: <br /> Are you booking your artists through The ArtsCenter's Arts in Schools Program? Ei YES 0 NO <br /> 2ui/ (',(hst ,c,i,,14 )airtirr Uford Applr <br />