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DocuSign Envelope ID:A0B1 EB25-DA83-4024-9927-D69B64746F70 <br /> fik641ePf ilOPOMg /E06n46.011 PE44fri in°001e knoOPt <br /> A. Admissions <br /> B. Contracted Services <br /> Revenue <br /> C. Other Revenue <br /> Corporate Support: <br /> D. Private Support Foundation Support: <br /> Other private support: ()peal 1:;17-1$4 $ . 00 <br /> Federal: <br /> E. Government Support State/Regional: <br /> Local(not including this request):0e104 Citr)P: $ <br /> F. Applicant Cash <br /> G. Grant Amount Requested $ 60' <br /> (in this application) <br /> H. Total Cash Income <br /> (must equal Total Cash $ 7, <br /> Expenses, Item G above) <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, <br /> one sided, 8.5 x 11 white paper. A digital copy of the application is not necessary. <br /> 1:"Application Form, including signature <br /> or Narrative <br /> O Detailed Budget(if necessary) <br /> la-I:Resumes of key artists involved in grant funded program(s) <br /> Sample programs, press, or other materials from this or similar past programs <br /> .0--Letters of support from community partners (if applicable) <br /> 0- work samples by artist(s), labeled with artists' name, title of work, date of work, produced in the last three years: <br /> cj2 Visual artists: CD, 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 DVD, or link to high-quality online video (3-5 minutes) <br /> o Music and spoken word: CD , MP3 or link to high-quality online video(3-5 minutes) <br /> o Literary arts: Manuscript (10-15 pages) submitted as .pdf file or hard copy <br /> PART 4: CERTIFICATION <br /> I understand that failure to respond to any of the above items may adversely affect the consideration of this application. I <br /> certify that I am committed to the completion of the proposed project in compliance with legal requirements and granting <br /> procedures. I certify that the information contained in this application, including attachments and supporting materials, is <br /> true and correct. <br /> APPLICANT <br /> Printed or typed name: dt4-1..e4,,— .41,-)bearf <br /> Signature: <br /> el)94:: 41114 / <br /> Date: 5,3/. <br /> (Mud.Ar. 1)6trofion Pnc 1(et <br />