Established 1947
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Arts Quincy, Illinois
Arts Quincy, Illinois
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Arts Quincy, Illinois
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Art$Dollar$
REQUEST FORM

Please contact us if you have any questions or special considerations by calling or emailing us at:

Organization:
Address:
Tax Exempt #
City:
Website:
E-mail:
State:
Zip:
President:
Phone:
Contact:
Phone:
Project Information
Project Title:
Grant Request:
$

Total number of persons served by the project:

Project description:

Does your organization have:
Board of Directors? yes no How many?
Paid Staff? yes no How many?
Non-Profit Status? yes no

Project Guidelines:

Have you received past funding from Art$ Dollar$ yes no

Year Amount: $

BRIEF DESCRIPTION OF PROGRAM:

 

PROJECT BUDGET: $

EXPENSES: Itemize below all expenses such as personnel, publicity, travel, etc.

ITEM:
ANTICIPATED CASH EXPENSE:
$
Total Cash Expenses:
$

INCOME: List sources of income including grants, ticket sales, etc.
ITEM ANTICIPATED CASH INCOME:
ANTICIPATED CASH INCOME:
$
Total Cash Income:
$


STATEMENT OF ASSURANCES

By checking this box I verify that all the information provided in this application is true and accurate to the best of my knowledge. I understand that all 2010 awarded funds must be requested by the grantee by December 31, 2010. I also understand that 2010 grant funds will be held for payment until 2009 evaluations are submitted.



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