Artist Grant Application "*" indicates required fields ELIGIBILITYSelect One* First Time Applicant Prior Applicant – did not receive grant Prior EAI Grant Recipient – grant completed and closing report submitted Prior EAI Grant Recipient – grant has been completed, but closing report has not been submitted and not eligible to apply for an EAI grant Prior Emergency Grant Recipient – closing report is not required 1. Artist serves in the EAI service area and is prepared to manage EAI grant, sustain proposed program and provide the required documents:List the specific geographic community/communities within the EAI service area, along with the specific locations*Upload Resume that clearly describes experience and minimum two year history of artistic work and accomplishments*Max. file size: 32 MB.Upload W2 or 1099 for most recent tax filing*Max. file size: 32 MB.DOWNLOAD REQUIRED TEMPLATE: PROPOSAL BUDGETUpload Proposal Budget using required template*Max. file size: 32 MB.[Must use required template. Title, date and number all pages. Budget must accurately total all expected expenses and revenue for proposed program, such as Fiscal Agent fee and EAI grant request. Incomplete budgets will not be accepted.]2. Artist’s Fiscal Agent is a 501C3 non-profit arts organization and can provide the following documents:Upload Fiscal Agent’s Letter accepting and confirming the specific responsibilities of the Fiscal Agent as listed in the guidelines*Max. file size: 32 MB.Upload Fiscal Agent’s IRS Determination Letter*Max. file size: 32 MB.Upload Fiscal Agent’s IRS 990*Max. file size: 32 MB.DOWNLOAD REQUIRED TEMPLATE: FISCAL AGENT ANNUAL BUDGETUpload Fiscal Agent’s Current Annual Budget using required template*Max. file size: 32 MB.[Use required template and title, date, and number page/pages. Budgets using a different format will not be accepted] GENERAL INFORMATIONArtist Legal Name* First Last Artist Title* Age*Select Artistic Discipline* Creative Crafts – Contemporary Art / Folk Art: Dance Film Graphic Arts Literary Arts Music Technical Arts Theatre Visual Arts Art Trade: (i.e., recording engineer, production assistance, set design, costume design, make-up artists, etc.) List specific craft (i.e, ceramics, woodwork, mosaic art, etc.) List one specific trade: Describe Artistic Work*Street Address* Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Mobile Phone*Email Address* Web Site Address Instagram Address Facebook Address Twitter Address PROPOSAL INFORMATIONProgram Title* Program Description (clear summary)*Program Purpose (significance, goals and expected outcomes)*Program Location/s with Address*If Public Art Project, upload: Approval Letter from property owner Approval Letter from municipality (if applicable) Upload approval letter from property ownerAccepted file types: pdf, doc, docx, Max. file size: 32 MB.Upload approval letter from municipalityAccepted file types: pdf, doc, docx, Max. file size: 32 MB.Program Benefit and Importance to Community (avoid using stats or data unless absolutely relevant)*Number of Participants to be Enrolled in Program:*Participant Age Group/s* 4-8 9-12 13-18 19-29 30-45 46-55 56-65 66 plus All ages Program Benefit to Participants / How Participants will Engage in Program*Total Number of Audience Participants*Audience Age/s* Program Benefit to Audience*Community Engagement*(What kind of engagement helped determine need for proposed program or project)Program Partners and Roles (i.e., community-based organizations, community volunteers)*Program Schedule of Activities & Event Dates*Program Implementation Plan (planning, launch, sustainability)*Program Outreach and Marketing Plan [75 Words Max]*Program Start Date* MM slash DD slash YYYY Program End Date* MM slash DD slash YYYY Program Evaluation and Next Steps with Program*FINANCIAL INFORMATIONGrant Amount Request: $*Proposed Program Total Cost: $*Remaining Funds to be Raised: $*Other Funders (received, commitments, pending funds)*Applicant Annual Income: $*Fiscal Agent’s Annual Budget Total: $*SAMPLE OF WORK REQUIRED – “Show Your Creativity”Upload Video [OR] Image of Work Related to Proposal [NOT BOTH]* (Sample work must be current and not older than one year) 1. Video URL – YouTube, Vimeo platforms, etc. [Maximum 2 mins - more than 2 minutes will be disqualified] 2. Upload ImageMax. file size: 32 MB.[Accepted file types: pdf, jpg, word doc, docx] FISCAL AGENTFiscal Agent Organization Name* Fiscal Agent Tax ID Number*Fiscal Agent Mission*Fiscal Agent Board of Directors and Affiliations*(Full Names, Board Titles, Professional Affiliations ONLY. Please do not include backgrounds or bios)Fiscal Agent Person in Charge Name* First Last Fiscal Agent Person in Charge Title* Fiscal Agent Office* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Fiscal Agent Office Land Line Phone Number*Fiscal Agent Person in Charge Mobile Phone Number*Fiscal Agent Person in Charge Email Address* Fiscal Agent Web Site Address* Fiscal Agent Instagram Address Fiscal Agent Facebook Address Fiscal Agent Twitter Address