Arts Project
Grant Application Form

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 _______________  

Hints for using this on-line application:  First, hit refresh on your browser to make sure you are using the most current version.  Second, do not allow the boxes to scroll since you will not be able to view that extra text when you print.  Third, remember that you cannot save so plan ahead.  Fourth, print off a copy and mail to our office with required original signatures and attachments.  Make sure your pages are printing with a size 10 font in the boxes, otherwise adjust your print settings accordingly.  Fifth, if you have a suggestion that would make this form function better email mara@nwrdc.org  Full Arts Project Instructions 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.)
4. Fiscal Agent (Agency Name, Address, Day Phone)
(Fill out Only if Applicable. A Contract Must Be Enclosed)


Phone
5.  People benefiting from activity
        Adult Artists Participating   
        Adult Audience                         
   
     Children/Youth Participating  
   
     Children/Youth Audience
Hint:  These numbers should be the same throughout application.
6. Project Budget Summary
       $     Total Project Cost
       $     Total Match 
       $     Amount Requested 
(Request cannot exceed 50% of the Total Cost.  Remember that request plus match should equal cost.  Numbers should be the same as main budget pages.)   
7.  Brief Project Description

Activity Dates
8.     Location of Activities

9.     Project Starting Date 
(Date a financial commitment has been made to the project. No earlier than two months after deadline.)
       
Project Ending Date

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

Proposed Project  

11. Give a complete description of the project, including dates and times of activities.

12. Ticket and Admission Information
A. Number of performances or days of exhibition:
B
. List the ticket price/s for this project:
C
. List ticket price/s you have charged for
similar events in the past two years:

D. How were ticket prices determined?

E. If you are not charging for this event, list the reasons why not:

F. What efforts have been made to seek financial support from the community for this project?


Merit and Artistic Quality                     

13. What are the specific goals of this project?

14. How will you evaluate the project?

15.   A. List the key artists, companies, professionals, and administrative personnel.
       B. Indicate why they were selected.
       C. Attach resumes for these people.


Need or Demand for the Project

16. How was the need for this project determined:
A. By artists?

B. By the community?


Ability of the Applicant to Carry Out the Project             

17. Give a brief description of all arts-related projects undertaken by your organization in the past two years, including dates.

18. Describe the publicity and/or marketing efforts, including how the participants and public will learn of the project, a description of the methods (news releases, posters, brochures, etc.) that will be used, and the range of distribution of the publicity.

19. List support received from the Minnesota State Arts Board and/or the Northwest Regional Development Commission over the past two years.  Attach extra pages is necessary.

Project Description Year Amount

20. Total Organizational Budget (Required by the state, please do not skip over.  If you have a question please email mara@nwrdc.org )

Year Prior to Project Year of Project
INCOME $
EXPENSES

Needs Assessment Questions:  this section is required and will help us to continue to assess the region's needs 

21.  In your community or county, what do you think is the greatest strength and what is most lacking in the arts?

22.  What are your needs, other than funding, as an artist, arts organization or non-profit organization pertaining to the arts?

23. How could Northwest Minnesota Arts Council help you fulfill the needs identified in question 2?


Proposed Budget
INSTRUCTIONS:

A. Clearly identify each item. D. In-kind is donated materials, labor, or
B. Show method of calculation space for which an in-kind voucher must
(i.e., hours, rate, cost per item, etc.). be submitted.
C. Round figures to nearest ten. E. Attach additional pages as necessary.

Project Expenses

ARTIST FEES, CONTRACTS, HONORARIUM CASH + IN-KIND = TOTAL
Name of Artist or Group:
SALARIES OR WAGES
(List positions individually - director, technicians, etc.)
Position                                     # hours @ $ rate
SUPPLIES AND MATERIALS (Expendable Items)
TRANSPORTATION AND SUBSISTENCE
PUBLICITY (Printing, Ads, etc.)
RENTAL (Include Source of Rental Materials)
OTHER
TOTAL PROJECT COST

Project Income
EARNED INCOME (Tickets, Fundraisers, Concessions, etc.  If more than one ticket price is used, indicate schedule.) CASH IN-KIND TOTAL
# Tickets @ $
# Tickets @ $
CASH (Indicate Source)
OTHER GRANTS (Do Not Include NWRDC Request.  Indicate if Other Grants are Secured.)
IN-KIND CONTRIBUTIONS (All In-Kind must be identified in Expense Section.  In-kind may not exceed 25% of the Total Project Cost.)
TOTAL MATCH FOR PROJECT + =
AMOUNT REQUESTED FROM NWRDC
(Cannot exceed 50% of Total Cost)
TOTAL SUPPORT FOR PROJECT
(Total Match + Request)

Checklist

Check the following that apply to this application:
1. The organization carrying out this project is: (check the one that applies)
        a unit of government. (Includes cities, and
departments or agencies of the state.)
         a non-profit, tax-exempt, 501(c)(3) organization, 
   
             and a copy of the IRS Letter of Exemption is enclosed or is on file with the NWRDC.
        applying through a fiscal agent and the fiscal agent contract is enclosed.
2. Resumes/qualifications of key project personnel (artists, companies, director, etc.) are attached.
3. Vouchers from donors of in-kind items/services/space are attached.