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DocuSign Envelope ID:9CBAA6B1-266B-4426-BDCC-20AAE9B937EF <br /> , , <br /> PART 3: APPLICATION CHECKLIST <br /> APPLICATION CHECKLIST <br /> Please compile in This order. Do 1-rot,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 n0 cossari,% <br /> Application Form, including signatures, <br /> at', Narrative <br /> Detailed Budget(if necessary) <br /> Ea‹,,Resumes of key artists and administrators involved in grant funded program(s) <br /> eV' lIncome and Expense statement for FYI 5-16 <br /> DK Budget or year-to-date statement for FY16-17 <br /> la/Budget for FYI 148 <br /> • Current Beard of Directors list <br /> O Copy of IRS Tax Exemption Letter, if applicable <br /> O Sample programs, press, or other materials from this or similar past programs <br /> O 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,: D. 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 DVID, or link to high-quality online video (3-5 rritni.ites) <br /> o Music and spoken word: CD , MP3 or link to high-quality online video(3-5 minutes) <br /> O Literary ads: Manuscript(10-15 papas)submitted as „odi file or hard copy <br /> PART 4: CERTIFICATION <br /> We understand that failure to respond to any of the above items may adversely effect the consideration of this application, <br /> We certify that we are committed to the completion of the proposed protect in compliance with legal requirements and <br /> granting procedures. We certify that the information contained in this application, including attachments and supporting <br /> materials, is true and correct lo the best of our knowledge. <br /> PROJECT DIRECTOR,(if applitabii) <br /> , _.„. <br /> Printed or typed name <br /> Jeffr- y J. York <br /> Signature <br /> Date: <br /> /6/02/201 / <br /> 1 I <br /> AUTHORIZING OFFICIAL (required) <br /> ........ <br /> Printed or typed name: <br /> __„„..,...„......„.„„ <br /> Jim On <br /> Signature: <br /> .....„ <br /> Date: <br /> 06/02/2017 <br /> __._., <br />