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onnunign Envelope ID:nEoAa1or-2ron-44CA-8o1n-5Aoaooxao57o <br /> A. Admissions <br /> D. Contracted Services <br /> Revenue <br /> X. Other Revenue � <br /> Corporate Support: � <br /> A. Private Support Foundation Support: � <br /> Other pnvate support: � <br /> Federal: � <br /> E. Government Support State/Regional: � <br /> Local(not including this request): � <br /> (D. Applicant Cash � <br /> C Grant Amount Requested $1'385.00 <br /> (in this application) <br /> H. Total Cash income (must <br /> equal Total Cash Expenses, $1'305i00 <br /> Item G above) <br /> PART 3: APPLICATION CHECKLIST <br /> ~ ^ ^^ ~~ �~ ^ ^^ ~ ~~^-' - '-'- <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 /> [] <br /> Application Form, including signature <br /> [] <br /> Narrative <br /> [] <br /> Detailed Budget(if necessary) <br /> [] Resumes of key artists involved in grant funded program(s) <br /> [] <br /> Sample pnognams, prese, or other materials from this or similar past programs <br /> [] <br /> Letters of support from community partners (if applicable) <br /> [] <br /> 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: 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 p ject 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 /> Printed or typed name: Pam Haggett <br /> Signature: 4 � <br /> /20101),),0e) <br /> ` ~--- - `— '^/ <br />