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DocuSign Envelope ID:A93DFB16-F899-47A7-98E9-B1FBA2F2F1B5 <br /> 1 10 <br /> 4k. rplZ <br /> 0 -z <br /> G/- 201718 <br /> ORANGE COUNTY ARTS co'\4* GRASSROOTS ARTS PROGRAM <br /> COMMISSION www.nearts.org APPLICATION FORM <br /> PART 1 : APPLICATION ORGANIZATION INFORMATION <br /> Organization Name: ivory el leAroert 0‘,)011i90 <br /> Street Address: 15,01 11c„).(ri re <br /> City: h fp(6 I I-1 I I State: ;NJ C Zip: <br /> Phone: cirri - 7 1 1,7 Website: (AJ4J1 vv13 es, <br /> Authorizing Official Name: Cry Ci.e)j rf I,$ <br /> Authorizing Official Title: p ri 1 <br /> Authorizing Official Phone: 6/ lei- (ii 71 t,c' Authorizing Official Email: (! pp s(:)0 00,1 ki 2,Ile, as <br /> Applicant Race: A.6i,ico. Awhe-,71,,,a ri Organization EIN: . <br /> ORGANIZATIONAL FINANCES <br /> Please attach a complete income and expense statement(an audit may be substituted)for your last fiscal year and <br /> complete operating budgets for the current fiscal year and next fiscal year. Public schools and other large governmental or <br /> community agencies should attach arts program financial information only. Please copy the totals from these attachments <br /> in the spaces below: <br /> Last Year Actual: FY15-16 Current Year: FY16-17 Next Year: FY17-18 <br /> Actual Income: $ 1ioo , DC) Projected Income: $ „;?); 700. 00 Projected Income: $ oil 5 OD, 00 <br /> Actual Expenses: $ ' o C---o Projected Expense: $ 0, D 0 Projected Expense: $ j çi (.), 0 0 <br /> PART 2: PROJECT INFORMATION <br /> PROJECT DIRECTOR INFORMATION (if different from Authorizing Official) <br /> Project Director Name: Set rd.I Co /1('' <br /> Project Director Title: r <br /> Street Address: j ) I ell(4 (e), I) ( el <br /> City: Ci/lecpe i State: Zip: 2 -7 5'1 4, <br /> Phone: ei Email: 5'ei) ryi e I- (ei)0 11(0 kl ie Ui <br /> PROJECT SUMMARY <br /> Title of Grant Program or Project: ertre,- jle.,:t 01 At/ape-4 EX1-y°c/tv(141'n v1 2 e).- kl"0-06 el <br /> Grant Amount Requested: t ),5-00,0 0 (,) L-1 LI <br /> Project Start Date (No earlier than July 1, 2017): ccef c2,b17 <br /> Project End Date (No later than June 30, 2018): /Art y I, 2O <br /> SCHOOLS ONLY: <br /> Are you booking your artists through The ArtsCenter's Arts in Schools Program? 0 YES NO <br />