Organization:

Address

Organization Contacts

Telephone

Email Address

Organization Contact Signature Date

Lead Artist Name & Address

Artist's Telephone Number Email Address

Lead Artist's Signature Date

Fiscal Sponsor (If used)

Address

Fiscal Sponsor Contact Signature

Please respond in the space provided: Brief project summary (25 words or less):

Format of completed work (including length):

How, where, and when will the work be presented (if known)?:

Amount Requested Project Budget

Project Starting Date Project Ending Date

Annual Organization Budget* (current fiscal year):

Total Organization Expenses* (from most recent year-end financial statement):

*Budget and expenses should come from the fiscal sponsor if one is used.

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Completed applications must be received by May 7, 2010