Date Received _____________

_________________________

UVA Use Only

 

UPPER VALLEY ARTS FUNDING REQUEST FORM

“Upper Valley Arts envisions a vibrant sustainable arts environment and cultivates diverse arts experiences for all residents and visitors to the Upper Wenatchee Valley through: Coordinating, Funding, Promoting, and Communication”.

Check which grant cycle you are applying for: ____ Deadline, June 1st.

____ Deadline, Dec. 1st

APPLICANT/ORGANIZATION NAME: ____________________________________

ADDRESS: _____________________________________________________________

TELEPHONE: __________________  E-MAIL: _______________________________

PROJECT LEADER/PRIMARY CONTACT:_________________________________

  PROJECT TITLE: ______________________________________________________

Are you a UVA member: Please Circle    YES  or  NO

If not a member, please explain:

 

1.       SUMMARY OF PROJECT (brief paragraph):

 

 

 

2.       In addition, please provide the following information about your proposed project:

Ø       Location:

Ø       Dates and times:

Ø       Partners and other organizations involved:

Ø       Completion Date:

Ø       What are the goals of this project?

 

 

3.       How does your project tie in with the mission of Upper Valley Arts as stated on page one of this application?

 

 

 

 

If you are an organization please answer numbers 4 & 5.  If you are an individual please go to number 6.

4.       4. How will your organization work with or link with other arts organizations or individuals in the proposed project?

 

 

5.       Please provide a copy of your organization’s budget with this application. (attach copy)

 

 

6.       Total Funding request from UVA: $_____________

 

 

7.       What else has been done to obtain funding and support for your project?

 

 

 

8.       Please provide an itemized budget for those funds that you are requesting from UVA.  Include how funds will be received (direct, bill, non-profit organization, etc.).

 

 

 

9.       When do you need the funding and what is this date important?

 

 

 

10.   How will UVA be recognized for its support?

 

 

Applicant Signature & Date: _______________________________________________

Signature of Officer of Organization & Date: ___________________________________

  Mail this form to:
Upper Valley Arts    w    P.O. Box 754    w    Leavenworth, WA 98826