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onnunign Envelope ID:ooFnonrn-C9nD-4e7o*7oo-51EeccrerunE <br /> PART 3: APPLICATION- - l � r 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 necessa!y. <br /> [] Application Form,on Form including signatures <br /> 0 Narrative <br /> 0 Detailed Budget (if necessary) - <br /> 0' Resumes of key artists and administrators involved in grant funded program(s) <br /> 0" Income and Expense statement for FYi 5-16 <br /> ca- Budget or year-to-date statement for FYI 6-17 <br /> 12/ Budget for FY17-18 <br /> CJ' Current Board of Directors' list <br /> 0/ Copy of IRS Tax Exemption Letter, if applicable <br /> Er. Sample programs, press, or other materials from this or similar past programs <br /> 0 Work samples by artist(s), labeled with artists' name, title of work, date of work, produced in the last three years: <br /> / -� a Visual artists: CD. DVD, or high resolution photographs (8 images per artist MAX), clearly labeled with <br /> ' �� <br /> /-, dimensions and media and indicate top of image <br /> �.�^���» ��� n Dance orthea��radiat: CDurOVD. ur link to high-quality online video (3'Sminutes) <br /> �/m/ y' -~ <br /> o Music and spoken word: CD , MP3 or link to high-quality online video (3-5 minutes) <br /> P°p50614, c-' 6`C- u Literary arts: Manuscript(1 0-15 pages) submitted as .pdf <br /> file or hard copy <br /> ���� ��` /�m�� <br /> . ' � . .~ �' / <br /> PART 4: CERTIFICATION <br /> We understand that failure to respond to any of the above items may adversely affect the consideration of this application. <br /> We certif that we are committed to the completion of the proposed projec 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 to the best of our knowledge. <br /> PROJECT DIRECTOR(if applicable) <br /> Printed or typed name: vaU rie Merritt <br /> Signature: ~- <br /> ~ r <br /> Oote: __ � �~� <br /> ~~- ^ ' y <br /> AUTHORIZING OFFICIAL(required) <br /> Shannon Grabowski <br /> �. <br /> Printed m�p� �me: *�� n��nn��n ��rau� �xU <br /> Signature: <br /> Cl/61 4/1(10-al/lA <br /> Date: 5, 27(. 11 <br /> � ' <br /> 2017 Grassroots Program Grant Application Packer 7 <br />