Grant Extension Request Form
After contacting staff to discuss your need for this extension, please complete this form to request a formal extension. Our Executive Director will review your request and inform you via email of his decision. As always, if you have any questions, please contact Wisconsin Arts Board staff via email at artsboard@wisconsin.gov or via phone at 608-266-0190.
What type of extension are you requesting?
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Final Report Extension
Grant Activity Extension
Grantee Summary
Name of Grantee Organization:
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Grantee Organization Address 1:
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physical address
Grantee Organization Address 2:
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physical address continued, PO Box, or N/A
Grantee Organization City:
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Grantee ZIP Code:
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Grantee Organization Phone:
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(###) ###-####
Format: (000) 000-0000.
Grantee Organization E-mail:
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Confirmation Email
preferably a generic email for your organization, different from the contact email address if possible
Grantee Organization Contact Name:
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First Name - Middle Name - Last Name
Grantee Organization Contact Title:
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Grantee Contact Phone:
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(###) ###-####
Format: (000) 000-0000.
Contact Phone Extension:
Grantee Contact E-mail:
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Confirmation Email
Grant Number: FYxx -xxxx
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e.g. FY21-1566
Grant Program
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ACI - Arts Challenge Initiative
CCP/AIE - Creative Communities, Arts Ed
CCP/FOL - Creative Communities, Folk Arts
CCP/LAA - Creative Communities, Local Arts
CPP - Creation & Presentation Program
FAA - Folk Arts Apprenticeship Program
RGT - Wisconsin Regranting Program
WIA - Woodland Indian Arts Program
XSA - Special Award
Other
Grant Amount Awarded:
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Project Start Date:
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Month
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Day
Year
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Requested New Project End Date:
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Month
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Day
Year
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Requested New Final Report Due Date:
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Month
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Day
Year
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Please explain why you are requesting this extension.
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