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DocuSign Envelope ID: 324CD765-DCA3-42C5-B339-89CADOBBF40E I <br /> 1 <br /> PART 3: APPLICATION CHECKLIST <br /> APPLICATION CHECKLIST <br /> Please compile in this order. Do not staple, bind, or pot into individual folders or sleeves. Provide one Copy, <br /> one skied, 8.5 x 11 white paper. A digital copy ot the application is nr)t necessary <br /> 1:1 Application Form, including signatures <br /> El Narrative <br /> El Detailed ;widget(if necessary) <br /> O Resumes of key artie z and administrators involved in grant funded program(s) <br /> El Income and Expense statement for F115-16 <br /> O Budget or year-to-date statement for FY16-17 <br /> 0 Budget for FY17-16 <br /> O Current Board of Directors list <br /> O Copy of RS 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 /> r) Visual artists: CD, DVD, or high resolution pbotogrophs (8 images per artist MAX), clearly labeled with <br /> dimensions and media and indicate top of image <br /> O Dance or ii eater artist: CD or DVD, or link to high-quality online video(3-5 minutes) <br /> 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 1 <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 /> -iiiiiii:111f DIRECT. .......... <br /> Printed or typed name: . <br /> Signature: <br /> [.. <br /> Date' Cristina Smith <br /> ., <br /> ...... __....„„„„„„....._ , .,......„_ <br /> AUTHORIZIPla OFEMIAL(requited) <br /> Printed or typed name: Jen CI <br /> Signature: <br /> Date Zel, I 7 <br />