Grant Extension Request Form
After contacting staff to discuss your need for this extension, please complete this form to request a formal extension. Our Director will review your request and inform you via E-mail of his decision. As always, if you have any questions, please contact Wisconsin Arts Board staff 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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