Arts Project Grant Application

Arts and Cultural Heritage Fund
Grant Application Cover Page

Northwest Minnesota Arts Council - NWRDC - 115 South Main - Warren, MN 56762

FOR OFFICE USE ONLY	Date Rcvd _______________	Application # _______________
Type _______________	Discipline _______________	Award Date _______________
Rating ______________	Grant Award _______________

This is the cover page for the full application. Please hit refresh on your browser to make sure you are using the most current version. Print off your completed copy and send to our office with the required signatures and attachments. Make sure your pages are printing with a size 10 font in the boxes, otherwise adjust your print settings accordingly. Entire Arts and Cultural Heritage Fund Application and Guidelines>>>

1. Applicant Organization (Legal Name, Address)

Phone
E-mail
Web Site
2. Project Director (Name, Address, Day Phone)

Phone
E-mail

3. Date of IRS Tax-exempt Letter
Already on file at Arts Council
Enclosed as attachment
(First time applicants must include a copy of the letter.)
5. Total Annual Organizational Expenses   $

      (Last completed year)
4. Fiscal Agent (Agency Name, Address, Day Phone)
(Fill out Only if Applicable. A Contract Must Be Enclosed)

Phone

6. People benefiting from activity
            Adult Artists Participating
            Adult Audience
        Children/Youth Benefitting
        Hint: These numbers should be the same throughout application.
7. Project Budget Summary
       $         Total Expense
       $         Amount Requested
(Request cannot exceed 90% of the Total Expense. Numbers should be the same as main budget pages.)

8. Main activity dates

Entire Dates from Start to Finish: -
9.     Location of Activities

10. Certification: We certify the information in this application is true and correct to the best of our knowledge. Make sure two different people sign off for the project with original signatures.

Typed Name Title Signature Date

Authorizing Official

Fiscal Agent

Project Director

1. Applicant Organization (Legal Name, Address) Phone E-mail Web Site	2. Project Director (Name, Address, Day Phone) Phone E-mail
3. Date of IRS Tax-exempt Letter Already on file at Arts Council Enclosed as attachment (First time applicants must include a copy of the letter.) 5. Total Annual Organizational Expenses $ (Last completed year)	4. Fiscal Agent (Agency Name, Address, Day Phone) (Fill out Only if Applicable. A Contract Must Be Enclosed) Phone
6. People benefiting from activity Adult Artists Participating Adult Audience Children/Youth Benefitting Hint: These numbers should be the same throughout application.	7. Project Budget Summary $ Total Expense $ Amount Requested (Request cannot exceed 90% of the Total Expense. Numbers should be the same as main budget pages.)
8. Main activity dates Entire Dates from Start to Finish: -	9. Location of Activities

	Typed Name	Title	Signature	Date
Authorizing Official
Fiscal Agent
Project Director