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POCAHONTAS COUNTY ARTS COUNCIL INC. GRANT APPLICATION |
PROGRAM GUIDELINES: The grant program of the Pocahontas County Arts Council Inc. is designed for supplemental funding to individuals or groups for specific "activities" (definition to include, but not limited to instruction, visiting artists and projects) or "items" (definition to include, but not limited to supplies, equiptment and materials) related to the arts. The activities or items being funded must NOT be used for direct and/or immediate profit (i.e., items purchased with these funds are not to be sold at a mark up.) Grants will be awarded on a first come first served basis, as moneys are available. The PCAC cannot guarantee to review applications received within 60 days of the need date. Individuals or groups receiving grants will not be eligible for additional grants during the same callendar year. In addition all final reporting requirements* from past grants must be met before new applications will be considered. *FINAL REPORTING REQUIREMENTS: All recipients will be required to submit a final report within 60 days of the completion of the project, purchase of materials, etc. As the funds for these grants are extremely limited, we STRONGLY encourage applicants to consider some method using the subject of this grant to benifit the community, willingness to do so will weigh in favor of the applicant. Examples could include (applicants are encouraged to think of their own circumstances and comfort level when deciding on a service): a) Teaching a free class to some segment of the community b) Donating completed projects to some non-profit orginazation c) Volunteering time and services to the community APPLICATION INSTRUCTIONS Read the guidelines and instructions carefully before completing the application. All questions must be answered even if not applicable (N/A). Incomplete applications will NOT be accepted. Application forms may be reproduced and a seperate application must be filled for each activity or item requested. Additional pages may be attached if the application does not allow sufficent room to thoroughly explain or list information. APPLICATION COVER SHEET Read certification information carefully, sign and date. The person who is responsible for seeing that the activitiy and all terms of the grant are carried out MUST sign certification. ACTIVITY / ITEM SUMMARY: A.) Attach any supporting documentation possible regarding cost and dates (copies of brochures, catalog plates, etc.) B.) List all additional expenses required in as mush detail as possible and attach any revelant documentation. C.) List all sources of assistance for this activity / item (i.e., other grants, family, self, etc.) D.) Be specific in the benifits expected from this activity or item. Also include, at this time, any community services you intend to perform and a timeline for performing such service. MAIL TO: PCAC, P.O. Box 251, Marlinton WV 24954 |
GRANT APPLICATION APPLICANT INFORMATION APPLICANT (or Orginization) NAME:__________________________________________________________ ADDRESS:_____________________________________________________________________________________ _______________________________________________________________________________________________ CONTACT PERSON (if Orginization):___________________________________________________________ TITLE:__________________________________________________________________________________ TELEPHONE NUMBER:_________________________________________________________________________ E-MAIL ADDRESS:_____________________________________________________________________________ CERTIFICATION I certify that the information in this application is true and correct to the best of my ability: NAME:_________________________________________________________________________________________ SIGNATURE:___________________________________________________________________________________ DATE:_________________________________________________________________________________________ |
A. Name of Activity / Item being applied for:_________________________________________________________________ Location:____________________________________________Start Date:_________________End Date:___________________ Registration Deadline:___________________________________________________________Cost:________________________ Amount Requested:____________________________________________ Brief description of activity / item:__________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ B. Additional expenses required (such as lodging, travel, etc. Please provide as much specific information as possible) ______________________________________________________________________________ $_____________________________ ______________________________________________________________________________ $_____________________________ ______________________________________________________________________________ $_____________________________ Total (A+B)___________________________________________________________________ $_____________________________ C. Applicant Resources (Please list all sources of funds, except this grant request, to be used toward this activity / item) ______________________________________________________________________________ $_____________________________ ______________________________________________________________________________ $_____________________________ D. Expected benefits from the activity (Please include indicators to be used to measure the success of the activity, who will beneft and how) ____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ |
PCAC GRANT FOLLOW-UP FORM |
ACTIVITY SUMMARY |
Grant Contact Person:_________________________________________________________________________________________ Activity Date:________________________________Amount of Monies from PCAC:____________________________________ Activity Location:______________________________________________________________________________________________ Number of people at/in attendance or otherwise present for the activity:_______________________________________ Please rate the success of the project or activity (1 to 5 with 5 being the higest)________________________________ Would you ask for funds for this activity again?_______________________________________________________________ After the activity, what would you anticipate to be of a benifit of such expenditures?__________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ In your opinion, what could be improved in this activity? What could make it better for those in attendance? _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Please attach any handouts distributed at the activity and specify here the quantity.___________________________ Please attach an itemized list of expenditures. Please include any photographs or other information to document the success of the program and specify the items. Other notes: Signature:__________________________________________________________________________Date:______________________ |