Grassroots Grant Application

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 *
Name of Contact Person *

First NameLast Name
Contact Person Title
Contact Person's Title

First NameLast Name
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Organization Website*
Name of Fiscal Sponsor/Agent if Applicable
Organization's EIN*
Or fiscal sponsor's
Organization's UEI
If applicable
Race/Ethnicity of Organization's Director or Applicant:

Black/African AmericanHispanic/LatinoWhite/Not HispanicAsianAmerican Indian/Alaskan NativePacific IslanderOther
Please give a brief description of your organization, including mission, board and staff composition. 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*
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.
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.
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Annual Budget

Please Enter Your Budget Numbers

Rows	Last FY	Current FY	Projected FY
Annual Budget
Income: Actual / Current / Projected
Expense: Actual / Current / Projected

* GRANT * APPLICATION *
Project Description
Project Title(s)*
Grant Amount Requested*
Project Start Date - July 1 of a fiscal year - If applying for operational support for multiple projects, put the start and end of your programming season.*
MM-DD-YYYY Format Please!
Project End Date - No later than June 30th of the fiscal year*
MM-DD-YYYY Format Please!
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*

0/25
Project goals. (Can list what the goal is and why- does not have to be in narrative form.)*
Description of intended participants/audience, including estimated numbers and racial and cultural composition*
Location where project will take place*
Description of project activities*
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 selected the artists, describe the types of artists you intend to involve and how you will select them. If your artist roster is too large - write "see attachment" and attach a document with your list of artists at the bottom of the form. *
(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:*
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*
How will you determine if it was a success?
Will this project supply multicultural artists or organizations? If no, write "NA". If so, please list the artists or organizations. If there are too many to list, please write "see attachment" and attach a document at the end of this form. You can also write what you know in this section and indicate if there will be more added at a later time. *
How will you determine if it was a success?
Will 50% or more of your project involve Arts Education?
Does your organization primarily serve black, indigenous, and people of color? Is your organization led by a BIPOC leader? Will the programming you are applying for be hiring BIPOC artists?
* GRANT * BUDGET *
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

Rows	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

Project Expenses*

Rows	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

Does your organization primarily serve black, indigenous, and people of color? Is your organization led by a BIPOC leader? Will the programming you are applying for be hiring BIPOC artists?

The leader of our agency is BIPOCOur organization primarily serves BIPOC populationBIPOC artists will be included in the Grassroots Grant programming that we are applying forOther

Projected Income

Rows	Income
Admissions
Contracted Services Revenue
Other Revenue
Corporate Support
Foundation Support
Other Private 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

Projected Income*

Rows	Income
Admissions
Contracted Services Revenue
Other Revenue
Corporate Support
Foundation Support
Other Private Support
Federal Government Support
State/Regional Government Support
Local Government Support
Applicant Cash
Grant Amount Requested in this application
Total Cash Income (Must at least equal Total Cash Expenses)
Other

Please Attach your notorized "No-Overdue Tax Forms" (can find on our Grassroots Grant Page of Website)

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Please Attach image for announcement of awards, it can be of your organization, promo materials for the event, or photos from a similar previous event. *

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Provide any other supporting documents.

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Certification

We understand that failure to respond to any of the above items may adversely affect the considerationof this application. We certify that we are committed to the completion of the proposed project incompliance with legal requirements and granting procedures. We certify that the information containedin this application, including attachments and supporting materials, is true and correct to the best of ourknowledge.
Name Position of Authorizing Official Contact Person *
Date*

MonthDayYear
Date
Signature of Authorizer:*
Should be Empty:

Grassroots Grant Application

Submit this report to your funding agency. It should not be submitted to the North Carolina Arts Council.

Organizational Finances:

Annual Budget

Project Description

Project Narrative

Project Budget:

Certification