for staff use

date received:

control number:

Michigan Council for arts and cultural affairs

MinigrantApplication

This application must be submitted by the deadline to be considered for funding. Before preparing the application read Minigrant Guidelines and Application Instructions. Codes needed to complete your application are listed on pages 14 - 16 of this booklet.(Authorized by Exec. Order 1991-92.) APPLICATION FORM REVISED04/01

 

 SECTION 1: APPLICANT ORGANIZATION INFORMATION

Organization’s Legal Name

Other Common Name, if applicable

Organization’s Official Mailing Address

City

Zip code

Organization’s Telephone Number

Fax Number

Office Hours

County Name

County Code

Authorized Official’s Name and Title

Organization’s Website (URL), if applicable

Board Chairperson

Board Chair’s Address

Federal Identification Number

____ ____---____ ____ ____ ____ ____ ____ ____

Status Code

Institution Code

Organization’s Discipline Code

U.S. Representative

District Number

State Senator

District Number

State Representative

District Number

 SECTION 2: PROJECT INFORMATION

Project Title

Start Date

End Date

Project Director’s Name and Title

Project Director’s Email Address

Project Director’s Address

City

Zip Code

Project Dir.’s Daytime Phone 

()-- 

Office Hours

Project’s Discipline Code

Project’s Primary County Name and Code

Have you applied, or are you planning to apply for other MCACA program grants (or Arts & Humanities Touring grant), for this project, or any overlap with this project? If Yes, which grant program?

Yes______No_______

If Yes, for how much funding?

$

Are you applying to any State of Michigan agency or department for support of this project?

Yes _____No ______

If Yes, to which agency or department?

If Yes, for how much funding?

$

 

 

 

 

 

 

 

 

 

 SECTION 3: PROJECT BUDGET SUMMARY

Total Match (Copy Box 1A)

$

Total Income (Copy Budget Line 12)

$

Total Expenses (Copy Budget Line 22)

$

Minigrant Request (Copy Budget Line 9)

$

Total Income must = Total Expenses; Matching Funds Test must be met

 SECTION 4: PARTICIPANT STATISTICS

Michigan Artists Participating

Dollars to Michigan Artists

$

Total Artists Participating

Dollars to All Artists

$

Number of Individuals Benefiting

Number of Youth Benefiting

REVISED 04/01MINIGRANT APPLICATION, PAGE ONE

Applicant Organizations Name:_______________________________________

Application Form, Page 2: PROJECT BUDGET

You must complete this form. It must be typed, complete, and accurate. Round dollars to the nearest whole dollar (do not include cents) and be sure that the budget balances. Breakdown the parts that make-up ATotals@ in each Line below in the Budget Itemization (Attachment 2).


 

PROJECT INCOME

CASH

 

IN-KIND

 

EARNED INCOME:

 

Line 1   Total Admissions          

$

Line 2   Total Other Earned Income

$

Line 3   TOTAL EARNED INCOME (Add Lines 1+2)

$

UNEARNED INCOME:

 

Line 4   Total Private Support (Corp, Fndn.,Indiv.)

$

Line 5   Total Public Support (All Gov’t. Grants)

$

Line 6   Total Other Unearned Income

$

Line 7   Applicant Cash

$

Line 8   TOTAL UNEARNED INCOME (Add Lines 4+5+6+7) 

$

Line 9   MINIGRANT REQUEST (Amount you are asking for)

$

Line 10  TOTAL CASH INCOME (Add Line 3 + Line 8 + Line 9) 

$

Line 11  TOTAL IN-KIND SUPPORT (Copy from Line 21)

$

Line 12  TOTAL PROJECT INCOME (Add Line 10 + Line 11)

$


 

PROJECT EXPENSES

CASH

IN-KIND

 

Line 13  Total Employee costs (Admin.+Artist.+Tech.)

$

$

Line 14  Total Non-Employee costs (Admin.+Artist+Tech.)

$

$

Line 15  Space Rental

$

$

Line 16  Travel

$

$

Line 17  Marketing, Promotion, Publicity

$

$

Line 18  Capital Expenses and Acquisitions

$

$

Line 19  Total Other Expenses

$

$

Line 20  TOTAL CASH EXPENSES (Must equal Line 10)

Add Lines 13-19, Cash Column

$

¯

Line 21  TOTAL IN-KIND EXPENSES (Must equal Line 11)

Add Lines 13-19, In-Kind Column

$

Line 22  TOTAL PROJECT EXPENSES (Must equal Line12)

 Add Lines 20 + 21

$

REVISED 04/01  MINIGRANT APPLICATION, PAGE TWO

 

Applicant Organizations Name:_______________________________________

Application Form, Page 3: 

Total Match, Matching Funds Test, and Assurances

Using Project Budget information (Application Form, Page Two), complete the following:


 

TOTAL MATCH

Add Line 3 + Line 8 + Line 11

BOX1A

$


 

MATCHING FUNDS TEST

Enter Minigrant Request (Copy from Line9)

BOX 1B

$

 

Multiply Line 1Bby2, and enter in Line 2B

BOX 2B

$

Enter Total Expenses (Copy from Line 22)

BOX 3B

$

Test:The Number in Box 3B (Total Expenses) must be equal to or greater than the number in Box 2B.

Using information from the Project Budget, Total Match, and Matching Funds Test (above), complete the Project Budget Summary (Application Form, Page One, Section 3).

  ASSURANCES

Your organization’s Authorized Official must sign this Assurances section, which must bear the original signature of an individual with legal authority to obligate your organization.

If a grant is awarded, the applicant gives assurance that:

A.    grant funds will be administered by the applicant,

B.    funds received under this grant will not be used to supplant funds normally budgeted for same and that funds received will be used solely for contracted Minigrant activities,

C.    the applicant has read and will conform to the Minigrant guidelines,

D.    the filing of this application by the undersigned individual who is officially authorized to represent the applicant organization, has been duly approved by, or will be approved by the governing board of the applicant organization.

The filing of this application was approved by the applicant organization's governing board on

 

           ___________________________________________________________

           enter     date     board    approved     your     filing    of   this   application

or

The filing of this application is scheduled to be approved by the applicant organization's governing board on

 

           ___________________________________________________________

           enter     date     board    approved     your     filing    of   this   application

Authorized Official:

___________________________________________

Type Name

___________________________________________________________

Signature date Assurances was signed

If the filing of this Minigrant application has not yet been authorized by your governing board, notify your Regranting Agency of the action taken as soon as possible. If notification is not received prior to application review, your project may not be recommended for funding.

REVISED 04/01 MINIGRANT APPLICATION, PAGE THREE

Applicant Organizations Name:_______________________________________

Application Form, Page 4:CHECKLIST

The following forms and attachments make up your application packet. As you are assembling and checking-off the following items, be sure that you include the minimum number of pages, but not more than the number of pages allowed. See Page 14 of the MCACA Minigrant Guidelines, for complete instructions on assembling and mailing your application.

PLEASE USE BOXES ( o ) NEXT TO EACH ITEM BELOW, TO CHECK-OFF ( 3) THE NUMBER OF PIECES THAT YOU INCLUDE IN YOUR APPLICATION PACKET.

APPLICATION FORM 

You must submit the original 4-page MCACA Minigrant application form plus 5 copies of the form (6 total).

Be certain that each section of each page is complete and accurate.

Page One (Cover page)..................................................................................................  o

Section 1:Applicant Organization Information

Section 2:Project Information

Section 3:Project Budget Summary

Section 4:Participant Statistics

Page Two (Project Budget page)....................................................................................  o

Page Three (Total Match, Matching Funds Test, and Assurances)...............................  o

Page Four (Checklist---this page)...................................................................................  o

REQUIRED ATTACHMENTS

The following must be attached to each application form. Be certain that each is complete and accurate:

Attachment 1: Project Narrative (No more than 3 pages)...............................................  ooo

Attachment 2: Budget Itemization (No more than 2 pages)............................................  oo

Attachment 3: Proof of Non-Profit Status (1 page)..........................................................  o

Attachment 4: Board of Directors List (No more than 1 page).......................................  o

Attachment 5: Project Director’s Resume or Bio Information (No more than 1 page)...  o

Attachment 6: Artist(s) Resume or Bio Information (No more than 1 page, per artist)..  ooo(…as needed)

Attachment 7: Current Letters of Support (At least 3, but no more than 6 letters).........  oooooo

Attachment 8: Organizational Profile (No more than1 page)..........................................  o

OPTIONAL ATTACHMENTS: Support Materials (No more than 5 items, total)

The following may be attached to the application packet and are encouraged, but not required: items such as brochures, programs, reviews, newsletters, artists' multi-page curriculum vitae, etc.)

Attachment 9: Support Materials (No more than 5 items)............................................... ooooo

KEEP COPIES OF EVERYTHING YOU SUBMIT. Mail your application packet to your Regional Regranting agency:

Greater Flint Arts Council

816 S. Saginaw

Flint, MI48502

REVISED 04/01 MINIGRANT APPLICATION, PAGE FOUR