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DocuSign Envelope ID: CE5B44DD-7CE5-417C-97E3-E68F3D29B718 <br /> PART 3: APPLICATION CHECKLIST <br /> APPLICATIGI 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 necessary. <br /> 0 Application Form, including signatures <br /> CI Narrative <br /> 0 Detailed Budget(if necessary) <br /> O Resumes of key artists and administrators involved in grant funded program(s) <br /> El Income and Expense statement for FY15-15 <br /> E3 Budget or year-to-date statement for FY18-17 <br /> U Budget for FY17-18 <br /> CI Current Board of Directors" list <br /> O Copy of IRS Tax Exemption Letter, if applicable <br /> • Shriplie programs, press, or other materials from this or similar past programs <br /> U Work,samples by artist(s) labeled with artists name„ title of work, date of work, produced in tne last three years! <br /> 0 Visual artists: CD, DVD„ or high resolution photographs (8 images per artist MAX), clearly labzhed with <br /> dimensions and media and indicate top of image <br /> O Dante or theater artist CD or DVD, or link to high-quality online video (3-5 minutes) <br /> o Music and spoken word: CD , POP3 or link to high-duality online video (3-5 minutes) <br /> O Literary arts, Manuscript(10-15 pages) submitted as „pelt file or hard copy <br /> PART 4: CERTIFICATION <br /> Vile understand that failure to respond to any of the above items may adversely affect the consideration of this application. <br /> We certify that we are committed to the completion of the proposed project in compliance with legal require rents 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 knovdedge. <br /> P004tOt colkEPTOR"(ft,4;U.Jtaible)r <br /> Printed or typed name: Allan M. Friedman <br /> Signature: ti 111 <br /> Date: 5/31 /2017 <br /> Printed or typed name: Laura B. A. Delauney <br /> Signature: Gait•, 4 "V— <br /> Date: 5/31 /2017 <br /> klIldk, N,Ir, <br />