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DocuSign Envelope ID:A9F5onco-32e1-46eA*4e6-E3e95Eo5eA6o <br /> '',“VPART3!,APPLICATION CHECKLIST' <br /> APPLICATION CHECI<LUST <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 <br /> Application Form, including signatures <br /> O Narrative <br /> O <br /> Detailed Budget (if necessary) <br /> O <br /> Resumes of key artists and administrators involved in grant funded program(s) <br /> [] <br /> Income and Expense statement for FY15-18 <br /> O Budget or year-to-date statement for FYi 6-17 <br /> [] 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 /> m Visual artists: CD, DVD. orhighreao\utiunphutographs (OinegosperadistKA%). clnor|y|abe|mdwith <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 /> n 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 mpplio3tion, including attachments and supporting <br /> matoha|s, is true and correct to the best of our knowledge. <br /> Printed or typed name: Donald Oehler <br /> Signature: <br /> Date: April 27, 2017 <br /> Printed or typed name: Merida Negrete <br /> y ' <br /> Signature: <br /> Date: April 27, 2017 <br /> 7 <br /> 20/7 Grassroots Program Grant Application Packet <br />