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DocuSign Envelope ID:B3B563FD-6D63-4031-A74C-538395FA5A15 <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 /> O Application Form, including signatures <br /> O Narrative <br /> O Detailed Budget(if necessary) <br /> O Resumes of key artists and administrators involved in grant funded program(s) <br /> 0 Income and Expense statement for FY15-16 <br /> O Budget or year-to-date statement for FY16-17 <br /> O Budget for FY17-18 <br /> O Current Board of Directors" list <br /> O Copy of IRS Tax Exemption Letter, if applicable <br /> O Sample programs, press, or other materials from this or similar past programs <br /> O 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 /> We 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 requirements 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 knowledge. <br /> PROJECT DIRECTOR(if applicable) <br /> Printed or typed name: Ambra Wilson <br /> Signature: <br /> LA / <br /> Date: P-1 <br /> AUTHORIZING OFFICIAL(required) <br /> Printed or typed name: Dr. Lisa Napo <br /> 112/ <br /> Signature: <br /> Ala <br /> Date: <br /> rL / i./ <br />