3135-0112 Grants for Arts Projects Forms

NEA Application Project Budget, Part 1

Read the instructions for this form before you start.

OMB No. 3135-0112 Expires 11/30/2007TBD W

Applicant (official IRS name):		     
INCOME
1. Amount requested from the Arts Endowment: $							     
2. Total match for this project Be as specific as possible. Asterisk (*) those funds that are committed or secured.
Cash (Refers to the cash donations, grants, and revenues that are expected or received for this project)								Amount
     								     
     								     
     								     
     								     
     								     
     								     
     								     
     								     
Total cash a. $								     
In-kind: Donated space, supplies, volunteer services (These same items also must be listed as direct costs under “Expenses” below or in Part 2 of the Project Budget form; identify sources)
     								     
     								     
     								     
     								     
Total donations b. $								     
Total match for this project (2a. cash + 2b. donations) $								     
EXPENSES 1. Direct costs: Salaries and wages
Title and/or type of personnel			Number of personnel	Annual or average salary range		% of time devoted to this project			Amount
     			     	     		     			     
     			     	     		     			     
     			     	     		     			     
     			     	     		     			     
     			     	     		     			     
     			     	     		     			     
     			     	     		     			     
     			     	     		     			     
Total salaries and wages a. $								     
Fringe benefits					Total fringe benefits b. $			     
Total salaries, wages, and fringe benefits (a. + b.) $								     

Applicant (official IRS name):			     
EXPENSES, CONTINUED
2. Direct costs: Travel (Include subsistence)
# of travelers		From					To			Amount
     		     					     			     
     		     					     			     
     		     					     			     
     		     					     			     
     		     					     			     
     		     					     			     
     		     					     			     
Total travel $										     
3. Direct costs: Other expenses (Include consultant and artist fees, contractual services, promotion, acquisition fees, rights, evaluation and assessment fees, access accommodations, telephone, photocopying, postage, supplies and materials, publication, distribution, translation, transportation of items other than personnel, rental of space or equipment, and other project-specific costs)
										Amount
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
     										     
Total other expenses $										     
4. Total direct costs (1. from Project Budget, Part 1 +2.+3.) $										     
5. Indirect costs (if applicable)
Federal Agency:	     			Rate (%)	  	x Base		     	= $	     
6. Total project costs (4.+5.) $										     

If you are a parent organization, this information should refer to the component on whose behalf you are applying. Do not complete this form if you are applying for a Challenge America Fast-Track Review Grant.
Applicant (official IRS name):			     
OPERATING BUDGET	Most recently completed fiscal year (  /  /   --   /  /  ) start date end date			Current fiscal year (estimated) (  /  /   --   /  /  ) start date end date		Next fiscal year (projected) (  /  /   --   /  /  ) start date end date
Income:
Earned $		     		$	     	$	     
Contributed $		     		$	     	$	     
Total Income $		     		$	     	$	     
Expenses:
Artistic salaries and fees $		     		$	     	$	     
Production/exhibition/ $ service expenses		     		$	     	$	     
Administrative expenses $		     		$	     	$	     
Total Expenses $		     		$	     	$	     
Operating surplus/(deficit) $		     		$	     	$	     
In the space below, discuss the fiscal health of your organization. You must explain 1) any changes of 15% or more in either your income or expenses from one year to the next, and 2) plans for reducing any deficit (include the factors that contributed to the deficit and its amount):      

To be completed only by the one primary consortium partner and included in the application package. Do not complete this form if you are applying for a Challenge America Fast-Track Review Grant.

Lead Applicant for Consortium (official IRS name):

     

Primary Consortium Partner’s IRS name:

     

Popular name (if different):

     

Primary Consortium Partner’s Authorizing Official

Mr. Ms.

First:

     

Last:

     

Address:

     

City/State/Zip Code (9-digit number):

     

Taxpayer ID Number (9-digit number):

   --      

Web Address: http://

     

Contact:

Mr. Ms.

First:

     

Last:

     

Title:

     

E-mail:

     

Telephone:

(   )     

ext.

     

Fax:

(   )     

Organization’s Total Operating Expenses for the most recently completed fiscal year (unaudited figures are acceptable): $

     

Mission/purpose of your organization:      

Briefly describe your organization’s involvement in planning and executing the consortium project including programming, management, finances, and any responsibilities for matching the Arts Endowment’s grant. Be specific; do not provide a general statement of support for the project. Use this space only.