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onnunign Envelope ID:oeoocCe4-5rn2-4ono*en5-nes100000roo <br /> PART 3: 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, one sided, <br /> 8.5 x 11 white paper. A digital copy of the application is not necessary. <br /> E3/„.Application Form, including signatures <br /> Narrative <br /> se/ Detailed Budget(if necessary) <br /> ra?'"Resumes of key artists and administrators volved in grant funded program(s) <br /> Income and Expense statement for FY15-16 <br /> or year-to-date statement for FY1O-17 <br /> forFY17-i8 <br /> o,"" Current Board uf Directors'list <br /> o Copy of IRS Tax Exemption Letter,if applicable <br /> Er Sample pmna peosor��hormahahe|e�nmtbisoruimi|orpaa\pmgrame <br /> ��'VVork samples— �by' rtiat(m . labeled with artists'name,title of work,date of work,produced in the last three years: <br /> o Visual artists:CD, DVD,or high resolution photographs(8 images per artist MAX), clearly labeled with dimensions <br /> and media and indicate top of image <br /> o Denoeortheaharertiet: CDorDVD. or|inktohigh-quaUtyon|inevidao(3-5minu1em) <br /> o Music and spoken word:CD. MP3or link t high-quality online video<3-5minu\es) <br /> o Literary arts:Manuscript(10-15 pages)submitted as.pdf file or hard copy <br /> PART 4: CERTIFICATION <br /> VVeundan�ond that failure tu respond\o any of the above items may adversely affect the oonoidemtiunof this application.VVemshify <br /> that weamcommi8adto the completion of�e proposed pn4ectinoompUonoavvith legal mquimmenbaand grundngpmcodunao.VVe <br /> omKifythat the infonnodoncontained in this app|icabon. in�udingoUachmentaand euppodingmabada|e, imtme and comaottm�hebaat <br /> of our knowledge. <br /> PROJECT DIRECTOR(if applicable) <br /> Printed or typed name: Lynn Weller <br /> Signature: _ <br /> Date: /«� � � ~_ <br /> AUTHORIZING OFFICIAL(required) <br /> Printed or typed name: Jillian LaSerna <br /> _- <br /> Signature: <br /> ����� �V ^�N�1 / �,� } <br /> �\- ��~«-�^� <br /> Date: <br />