3135-0112 Financial Infomration Form

OMB No. 3135-0112
Expires 11/30/2010

Read the
instructions for
this form before
you start.

NEA Application

Financial Information

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):

MOST RECENTLY COMPLETED
FISCAL YEAR

OPERATING BUDGET

(

/

/

START DATE

--

/

/

END DATE

)

CURRENT FISCAL YEAR
(ESTIMATED)

(

/

/

START DATE

--

/

/

END DATE

NEXT FISCAL YEAR
(PROJECTED)

)

(

/

/

START DATE

Income:
Earned

$

$

$

Contributed

$

$

$

Total Income

$

$

$

Expenses:
Artistic salaries and fees $

$

$

Production/exhibition/
$
service expenses
Administrative expenses $

$

$

$

$

Total Expenses

$

$

$

Operating surplus/(deficit)$

$

$

--

/

/

)

END DATE

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):