(cad) grant application - Worcester County Arts Council

Page 1 of 4 - WCAC Grant Application
For Arts Council Use:Grant #
Date Received:
Date Approved/Denied:
WORCESTER COUNTY ARTS COUNCIL
COMMUNITY ARTS DEVELOPMENT GRANT APPLICATION FORM
NOTE: All requested information must be completed. If the requested
information does not apply to your project, please indicate by writing N/A.
Organization:
Address:
(Street)
(City)
(State)
(Zip)
Contact Person:
Telephone:
(H/W)
(Cell)
Email Address:
Name of Project or Event Planned:
Date & Time of Project:
(Date)
(Time)
Amount of Grant Requested:
Grant to be used for (be specific):
Handicapped accessible location where event will be held:
Is this a new project?
(Yes)
(No)
Has your organization ever received a WCAC Grant before? If yes list dates and amounts received
Date
Amount
/ Date
Amount
/ Date
Amount
/
Date
Amount
/ Date
Amount
/ Date
Amount
/
What is the projected attendance?
1. For project (such as a fair, performance, concert, exhibit)
2. For activity (such as camp or classes)
Form Revised: 03/01/2013
Page 2 of 4 - WCAC Grant Application
NOTE: All requested information must be completed. If the requested information
does not apply to your project, please indicate by writing N/A.
PROJECT BUDGET
A. CASH INCOME: Lines 2 (a - f) must equal or exceed grant request Line 1
1. Grant Amount requested (must be same as on page 1)……………………………….. $
2. Organization Funds:
a. Total Project Admission: (Based on projected attendance of (
)
$
b. Membership/Cash contributions: ………………………………………….
c.
$
Other Grants (specify sources and expected amount)
…………………..………… $
…………………..………… $
d. Total Activity Fees: (Based on projected attendance of (
)
$
e. Advertising Income: …………………………………………………………………
f.
$
Other Income (Itemize)
…………………..………… $
…………………..………… $
SUB-TOTAL Lines 2 (a - f) must equal or exceed grant request Line 1 …… $
TOTAL CASH INCOME: (Line 1 + sub-total for lines 2 (a-f))……………………… $
*
* TOTAL CASH INCOME must equal TOTAL CASH EXPENDITURES below
B. CASH EXPENDITURES
1. Fees:
a. Artistic: …………………………………………………………………………………… $
b. Technical: ………………………………………………………………………………… $
c. Administrative: *………………………………………………………………………… $
* Such as: Permits, licenses, clerical and financial assistance
2. Supplies & Materials: …………………………………………………………………………… $
3. Equipment: ……………………………………………………………………………..………… $
4. Promotion & Advertising: …………………………………………………………..………… $
5. Travel: ……………………………………………………………………………..……………… $
6. Rentals: ……………………………………………………………………………..……………
$
7. Other expenses (Itemize):
…………………..………… $
…………………..………… $
TOTAL CASH EXPENDITURES: …………………………………………………….….…. $
*
* TOTAL CASH EXPENDITURES must equal TOTAL CASH INCOME above
Form Revised: 03/01/2013
Page 3 of 4 - WCAC Grant Application
Please provide a detailed description of your project. Include the
specific purpose for which this grant is requested and what grant
funds will be used for.
Project Budget Narrative: Please provide a further description of
your project itemized expenses and income outlined on this
application.
Form Revised: 03/12/2013
Page 4 of 4 - WCAC Grant Application
C.
ADDITIONAL REQUIRED INFORMATION
1. Is your organization a branch of any government?
2. If no, is it incorporated in the State of Maryland?
3. Has organization been granted tax-exempt status by the IRS?
a. If yes:
(1) Is a copy of the Letter of Exemption from IRS on file with the
WCAC?
(2) A copy of the Letter of Exemption from the IRS must accompany this grant
form unless a copy is on file with the WCAC
b. If no,
(1) Is tax-exempt status pending?
(2) Please include the letter from the IRS indicating the pending status.
4. The following additional information must be attached: (Not required of Worcester
County public schools or other government agencies)
a. Detailed financial statement including income and expenditures for organization's
last completed year.
b. Detailed projected budget including income and expenditures for present year.
c. Current list of Officers and Board of Directors.
I certify that the information and financial figures contained in this grant
application and attachments are true and accurate.
Signature of Organization's Authorized Official:
Title of signer:
Print or Type Name of Signer:
Date signed:
Form Revised: 03/12/2013
APPLICATION CHECKLIST
MUST BE SENT IN WITH APPLICATION
PLEASE ATTACH TO TOP SHEET OF APPLICATION
Name of Organization:
Name of Project:
1. Original, plus seven (7) copies of application, including any additional
information attached to each, must be received at the Worcester
County Arts Council at 6 Jefferson Street, Berlin MD 21811 no later
than the application deadlines specified in the Council’s Grant Program
Guidelines.
2. Detailed financial statement including income and expenditures for
organization’s last completed year. *
3. Detailed projected budget including income and expenditures for
present year. *
4. Current list of officers and Board of Directors, if applicable. *
5. First time applicants must submit a copy of exemption from the IRS.
* Public schools and government agencies are exempt.
IN ORDER FOR YOUR APPLICATION TO BE CONSIDERED, ALL
REQUIREMENTS MUST BE MET FULLY AND ACCURATELY!
OLDER VERSIONS OF APPLICATION FORM WILL NOT BE CONSIDERED
Form Revised: 03/12/2013