EmailMe Form - Special Project Application JUNE 30, 2017

Project Title: *

Amount Requested
Max $2000. *

This is our first application to FKCA: *

Yes

No

If no, the previous application:

Was Funded

Was Not Funded

Continued: previous application was submitted:

as an individual

as part of a group

Continued: previous application submitted by whom: *

We have received Special Project funding (quantity) times.

If none insert 0

Applicant is: *

Individual artist (resume & proof of residency required)

Non-profit arts orgainization (IRS 501c3 required)

Ad hoc/unincorporated arts organization (mission statement required)

Attach resume, proof of residency, 501c3, mission statement here *

Acceptable formats: pdf, doc, docx or txt

Contact Information

Name of artist/organization *

Contact person *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Telephone *

### - ### - ####

email *

Web Site

Description of Project

A. Need (why are you seeking funding?)
B. Goal (what will you do?)
C. Methods (how will you do it?)
D. Use of funds (how will you spend the grant money?)
E. Future support anticipated from other sources
F. Results (what difference will you make in your world?)
G. Evaluation (How will you measure the success of the project?)

Description:
Please answer each item A-G in the space provided. *

Budget

A. Expenses

Artistic fees

$ Dollars . Cents

Supplies & materials

$ Dollars . Cents

Other

$ Dollars . Cents

Expense: project totals *

$ Dollars . Cents

B. Income (this grant)

Artistic fees

$ Dollars . Cents

Supplies & materials

$ Dollars . Cents

Other

$ Dollars . Cents

Income: project totals *

$ Dollars . Cents

C. Income (other funds)

Artistic fees

$ Dollars . Cents

Supplies & materials

$ Dollars . Cents

Other

$ Dollars . Cents

Income: project totals *

$ Dollars . Cents

If total project budget exceeds grant amount requested, please describe other funding sources, including any in-kind contributions. you may add more detail as appropriate. The total in section A should equal the total of sections B + C. *

If awarded a lesser amount than requested can you still complete the project? *

Yes

No

If yes, how will that alter the project? If no, please insert N/A *

Are you currently a member of the Florida Keys Council of the Arts? *

Yes

No

Checking this box acts as my electronic signature *

I verify all information in this application is correct

Email