Grassroots Grant Application
Submit this report to your funding agency. It should not be submitted to the North Carolina Arts Council.
Name of Organization Applying for Funding
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Name of Fiscal Sponsor/Agent if Applicable
Name of Contact Person
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First Name
Last Name
Contact Person Title
Contact Person's Title
First Name
Last Name
Organization Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
Organization Website
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Organization's EIN
*
Or fiscal sponsor's
Race/Ethnicity of Organization's Director or Applicant:
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Black/African American
Hispanic/Latino
White/Not Hispanic
Asian
American Indian/Alaskan Native
Pacific Islander
Other
Please give a brief description of your organization, including mission, board and staff composition.
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Please give a brief description current arts programs and services and number and kinds of people served. Public schools and other large governmental or community agencies should provide a description of their arts program only rather than the entire organization.
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Organizational Finances:
Please attach complete income and expense statement (an audit may be substituted) for your last fiscal year and complete operating budgets for the current fiscal year and next fiscal year. Public schools and other large governmental or community agencies should attach arts program financial information only. Please copy the totals from these attachments in the spaces below.
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Annual Budget
Please Enter Your Budget Numbers
Last FY
Current FY
Projected FY
Annual Budget
Total Income
Total Expense
*
GRANT
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APPLICATION
*
Project Description
Are you a BIPOC organization or do you plan to provide multicultural programming?
Please Select
Yes
No
Not Sure
Will 50% or more of your project involve Arts Education?
Please Select
Yes
No
Project Title(s)
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Grant Amount Requested
*
Project Start Date (No earlier than July 2024) If applying for operational support for multiple projects, put the start and end of your programming season.
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/
Month
/
Day
Year
Date
Project End Date (No later than June 15, 2025)
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Month
/
Day
Year
Date
Project Narrative
Please include a narrative providing the information requested below for the project you purpose and impact. Please be concise and specific as possible:
Project summary description
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Project goals
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Description of intended participants/audience, including estimated numbers and racial and cultural composition
*
Location where project will take place
*
Description of project activities
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Description of the artists to be involved in the project, how and why they were chosen and, if appropriate, the rate of payment for their services. (If you have not yet selected the artists, describe the kinds of artists you intend to involve and how you will select them.) Please also indicate their race: B = Black/African American, A = Asian, H =Latino/Hispanic, P = Native American/Indian, W = White/Caucasian
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(If you have not yet selected the artists, describe the kinds of artists you intend to involve and how you will select them.)
Description of how the project will be publicized and promoted to reach intended participants:
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Applicants are required to include NC Arts and Watauga Arts Council logos as sponsors of your project. Mention of our organizations should be included in press releases, flyers, websites and more. You will be required to submit samples of promotion for your programming in your end-of-season report.
Description of how you will evaluate the project
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How will you determine if it was a success?
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GRANT
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APPLICATION
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Project Budget:
Please provide a projected budget for your proposed project utilizing the format below. Applicants ARE required to match funds received. If you do not have income or expenses in a given row, please enter 0 (zero).
Project Expenses
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Cash Expenses
Grant Amount Requested
Applicant Cash Match
Administrative Staff
Artistic Staff
Technical/Production Staff
Artistic Contracts
Other Contracts
Space Rental
Travel
Marketing
Remaining Project Expenses
Total Cash Expenses
OTHER
Projected Income
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Income
Admissions
Contracted Services Revenue
Other Revenue
Private Support
Corporate Support
Foundation Support
Other Private Support
Government Support
Federal
State/Regional
Local
Applicant Cash
Grant Amount Requested in this application
Total Cash Income (Must at least equal Total Cash Expenses, Item G above)
Other
Please Attach your notorized "No-Overdue Tax Forms" (can find on our Grassroots Grant Page of Website)
*
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Certification
We understand that failure to respond to any of the above items may adversely affect the consideration of this application. We certify that we are committed to the completion of the proposed project in compliance with legal requirements and granting procedures. We certify that the information contained in this application, including attachments and supporting materials, is true and correct to the best of our knowledge.
Name Position of Authorizing Official Contact Person
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Date
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Month
/
Day
Year
Date
Signature of Authorizer:
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