Artists' Fellowship Inc. Financial Assistance Application

NOTE: The Artists' Fellowship provides limited financial aid to professional visual artists and their families in times of serious emergency caused by sickness, disability, natural disaster, or bereavement. Practicing artists with a long career will be given preference, but artists at all stages of their career are welcome to apply. Assistance is given without expectation of repayment. We do not provide grants or fellowships: requests for funding to support study, travel or exhibitions, or to purchase art supplies, will be denied. Long-term support should not be expected.

Please take a moment to read this before filling in your application.

CHECKLIST: The following material must accompany this application. We suggest you gather this information in one place on your desktop for easy uploading. Kindly label all documents, e.g. "bill_credit_card.pdf" "studio_lease.pdf," etc.

1. Letter: In no more than two pages, please explain 1) the nature of your serious emergency; 2) how the emergency has impacted you and your family, including how it has affected your ability to continue working as an artist; and 3) the total amount of aid you are requesting and a breakdown of this amount, so that the individual items add up to the total. You will be asked to provide documentation for each item requested.

2. Taxes: Please provide signed copies of your household's last two years of complete IRS tax returns including Schedule Cs. PLEASE UPLOAD THE ENTIRE TAX DOCUMENTS. (If you do not have a Schedule C, please explain).

3. Documentation: Please provide documentation about your serious emergency. This might include photos of damaged property, medical records, a death certificate or funeral bill, etc.

4. Resumé or CV: Please include an updated resume showing your exhibition history, awards, fellowships, permanent collections, etc.

6. Art Work: If you DO NOT have a website with your current work, upload 10 images, JPEGs of 2 MB or smaller. Please don't upload images if you have a website.

5. Press: If not on your website, please include articles from exhibitions, or anything that documents your long time involvement in the visual arts.

All candidates please complete the following before going to the next page.

Date:*

MonthDayYear

Legal Name:*

PrefixFirst NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Best number to reach youFormat: (000) 000-0000.

Age*

Email*

example@example.com

Number of years you have received income for your artwork:*

Schools Attended (after high school, if any) :

List schools here

If you are a member of any art organizations, please list name(s):

Organizations and clubs separated by comma

Describe the members of your household and their ages:*

Can your children and/or your parents offer assistance? If not, why?*

Friend/FamilyOn-line searchOther ArtistsOther

Health Insurance: List your health/medical plan and the limits, if any, of coverage: *

If you do not have insurance please indicate here.

MedicareMedicaidNoneOther

If your property was damaged, do you have homeowners/renters or car insurance that will cover some of the costs?

List terms of home/renter/car insurance information

Are you currently employed, and if so, please describe below:*

Your adjusted gross income as reported on your last tax return (line 11 of Form 1040)*

US Dollar Amount

Your household's total annual income from all sources (wages, sales, social security, pensions, stocks, bonds, real estate, trust funds, etc.), if this is different from your Adjusted Gross Income.

US Dollar Amount

Non-liquid assets (real estate equity, and other):*

Enter 0 if you do not own any assets

Monthly mortgage, maintenance, or rental payment:*

Do you have outstanding bills currently? Please list source and amount.*

Please list any other organizations to which you have recently applied for financial assistance:

If you have received grants/awards within the past 12 months, please list the source and amounts here:

Enter sources and amounts separated by comma

YesNo

If yes, when did you apply, and what was the outcome?

Enter the years(s) and amount, if applicable

The Artists' Fellowship provides limited financial aid to professional visual artists and their families in times of serious emergency, including dates. For example: natural disaster or a medical/dental condition, or the consequences of certain accidents, causing personal injury or property damage. General indebtedness or lack of employment will not be considered a serious emergency.*

Please be specific0/300

Financial assistance you are requesting from Artists' Fellowship:*

please put dollar amount i.e. $100.00

Describe how you would use the financial aid requested, providing dollar amounts for individual items so that they add up to the total amount requested. *

How aid would be used0/300

Signature

1. Please upload a letter of no more than two pages explaining 1) the nature of your emergency situation, including dates; 2) your financial situation and how you are making ends meet; 3) how the emergency has impacted you and your family, including how it has affected your ability to continue working as an artist; and 4) the total amount of aid you are requesting and a breakdown of this amount, so that the individual items add up to the total.*

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Letter detailing need

2. A signed copy of your most current IRS federal tax return, including Schedule C. Please upload the entire tax document. State tax returns are not necessary. If you do not have a Schedule C, please explain in your letter.*

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Most current federal tax return

3. A signed copy of your previous year IRS federal tax return, including Schedule C. *

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Previous year federal tax return

4. Copies of official documents supporting the amount requested. These can include but are not limited to the following: medical or dental expenses, funeral expenses, rent and utility bills (if you are in arrears), repair bills to your home and/or studio resulting from a disaster. Please label accordingly.*

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Bills and Invoices

5. Any documentation that would help us understand your emergency (for example, a doctor's note, or photos of property damage) if this is not already clear from the other documents you have provided.

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Bills and Invoices

6. Resumé or CV which should include your exhibition history, awards, fellowships, permanent collections, etc. (Please include materials from exhibitions, articles, or anything that documents your long time involvement in the visual arts.)*

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Resume or CV and other documentation

7. An image of a current driver's license, passport, or other form of official ID. Please label accordingly, e.g. "John Doe license":*

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ID

YesNo

Please provide your current website address*

ex: www.artistwebsite.com

Please upload 10 images of recent artwork. (JPGs no larger than 2 MB each)*

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JPGS 2 mb or less

Artists' Fellowship Inc. Financial Assistance Application

Personal Information

Art Background

Family Information

Insurance Information

Financial information

Please upload the following: