Part I: THE ORGANIZATION

Organization's Name
Address
Contact Person's Name
Address
Day Phone: Home Phone: Email:

Is the organization applying for or receiving funding from any other sources for this project? If so, please list the sources and amounts:

Number of people directly involved Projected attendance
Check appropriate discipline(s):

Visual Arts	Music	Dance
Theater	Literary	New Genre

Briefly explain the proposed project:

State the objective and how it addresses the community's need:

Indicate how the community will actively participate:

Indicate your plans to publicize:

Describe the kind of community support you have for this proposal (i.e. use of volunteers, space, donated supplies, etc.) {this used to be listed as "in kind" support}

Indicate the target number of participants and appropriate age group:

Timetable (include schedule, duration, number of sessions, etc.)

Neighborhood to be served and site location:

Support Materials Enclosed (Please List)

Part III PROJECT BUDGET (Total cash income must equal total cash expenditures.)

CASH INCOME		CASH EXPENDITURES
Tickets/Registration/Membership	$	Fees	$
Cash Contributions	$	Salaries	$
Organizational Funds	$	Supplies/Materials	$
Itemize all other sources of cash:		Equipment	$
	$	Promotion	$
	$	Travel	$
	$	Rentals	$
	$	Other (itemize)	$
	$		$
KCAC Request	$		$
TOTAL CASH INCOME	$	TOTAL CASH EXPENDITURES	$

I certify that the information and financial figures contained in this application are true and accurate.
Signature (Organization's Authorized Official: )

Name:		Title:
Address:		Phone:
Date:

Mail the printed form to: Kent County Arts Council, Inc. P.O. Box 330 Chestertown, MD 21620

or press: or: