Form 3135-0112 Application Update Form (Tentive Funding Recommendation)

OMB Number: 0000-0000
Expiration Date: MM/DD/YVYY

TENTATIVE FUNDING RECOMMENDATION
Time remaining to finalize and submit this form: DO Days HH Hours
Applicant Name: [pre-fill] on behalf of: [only visible if independent component] [pre-fill]
NEA Application #: [pre-fill]
Recommended Amount: [pre-fill]
Requested Amount: [pre-fill]
Period of support: [pre-fill] to [pre-fill]
NEA Discipline/Office: [pre-fill]
Award Purpose: [pre-fill (to support statement)]

Part 1: Project Changes
Can you still undertake the project? [single select]
• Yes (no changes to original proposal)
• Yes, but with changes to original proposal (revised project
• No, we can no longer undertake the project
o [prompt to contact someone at NEA]
Original period of support dates: [pre-fill]
• ~rt~~
• End Date

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If you have a new period of support, eri.l~r t~:~ates'~aw. [MM/DD /YYYY]

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After considering the fun~ recommeA;~",~itm, select either option A or option B. [question
visible to all respondent$:J:)tiii~"onIY be ari~~:~red if respondent selects "Yes, but with changes" to
/»>'
first question above.] ;~~f'
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.
• A: Increase our; rna
ganizalion will increase its match to cover the difference between the
amount reque:~~d:~~,,~d t ,/:tentative funding recommendation. The project and budget will remain
essentiall~!,~e sa:~e>:3ttl:'!,>~:;tJ~\~pplication. All costs will be incurred within the period of support
specif~~~j>ffi'l:le ap:ili:Ij~irtio'it;ar as noted below. [Note: If you elect this option, NEA staff will adjust
t~::reflect
an increased match]
the prol~t ~~~~et
...
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.
• ..JJ~::WI!~~~d~~ niaK'e;:~flanges and/or revise the budget: Given the recommended funding amount,
";~y orga'~i~i;lt'fo\:!=an do the project but will need to make changes (e.g., scope of activities,
pa'~i:e;ipant~/:;products, and/or the budget).
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Par;2~ Revised Project Budget

1

OMB Number: 0000-0000
Expiration Date: MM/DD/YVYY

TENTATIVE FUNDING RECOMMENDATION
Time remaining to finalize and submit this form: DO Days HH Hours
Applicant Name: [pre-fill] on behalf of: [only visible if independent component] [pre-fill]
NEA Application #: [pre-fill]
0loI3

Revised Project Budget

t-i;).

JUS-1m2

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_.7.126'12

Application # (pre-award changes):

2!. Award # (post-award changes):

1. Applicant (official IRS namelmailing address):

2. Period of Support Requested

I

I

(Use 2-digit numerals. e.g .. 01101113 for Jan. 1.2013):

Starting

3. Revised Project Description. Jf it is neoessary to revise your project clearly desetiboe how the recommended grant and ma1ching
funds would boe spent. Give a jllSlI1ieation fer !he change (e.g .. rt!duced amount of funding re<>ammended as conveyed by the
Endowment).

4. Project Budget Summary:
Amount Recommended

$.

Plus "Total match for this project"

L - I _ _ _ _ _- - - '

D

5. Authorizing Official (Last. first):

Mr.

D

Ms.

D

Ms.

Title:
Telephone:

Fax:

ext..

E-Mail:

Oate-:

6. Project Director (Last first}:

D

TItle:
Telephone:

Mr.

E-Mail:

Fax:

ext..

Project Budget
Income

n

7. T etal MATCH for this project. Be as specific as possible. Asterisk
those funds that are committed Of securt!d.
CASH {refers to !he cash dona~ons. grants. and revenUES that are expeeled or received for this project.}

Total cash a. $
IN-KINO (lilese same items aiso must be listed as direct cos.1s under "Expense.s· below.)

Amount

Teta! in-kind b. $
Total MATCH for this project (a. ~ b.) $

2

OMB Number: 0000-0000
Expiration Date: MM/DD/YYYY

TENTATIVE FUNDING RECOMMENDATION
Time remaining to finalize and submit this form: DO Days HH Hours
Applicant Name: [pre-fill] on behalf of: [only visible if independent component] [pre-fill]
NEA Application #: [pre-fill]

Revised Project Budget
8.

Direct QOSts: SALARIES AND WAGES (Do not include salaries associated with fund raising.)

rille and/or type of personnel

Number of

Annual or average salary
range

personnel

'1& of time dl!llOted 10
!his project

ArnoUll'tt

Total salaries and wages 3. $
Total fringe benefits b. $

Fringe benefits

Total salaries, wages, and fiinoe benefits (a. + b.) $
9.

Direct costs: TRAVEL (Indude 5Ubsistence.)

To

From

Total trawl $

10.

Direct costs: OTHER EXPENSES (such as consullaint and artist fees, conlraclual seMces. telephone. utiiIities, ~,
postage, supplies and materials. publication, distribution, transportation of items other Ih.-. personnel, rental of space or
equipment. etc.)
Amount

Total other expenses $

$

11. Total DIRECT COSTS (8.+9. +10.)
12. INDIRECT COSTS (if applicable. Include a copy of federal indirect cost rate agleetilll!l It):
Rate (%1

13. TOTAL PROJECT COSTS 111. + 12.)

=$
$

3

OMB Number: 0000-0000
Expiration Date: MM/DD/YVYY

TENTATIVE FUNDING RECOMMENDATION
Time remaining to finalize and submit this form: DD Days HH Hours
Applicant Name: [pre-fill] on behalf of: [only visible if independent component] [pre-fill]
NEA Application #: [pre-fill]

Part 3: Project Description
• ~~ii
"In-person" Arts Experience: Enter the number of people expected to dir~l~$::""~~it~:;the
Project Outcomes

arts, whether through attendance at arts events or participation in arts learning 0 ther ~,\s of
' 0 will
activities that involve people directly with artists or the arts. Do not~~¥nt indiY'id
primarily be reached through TV or cable broadcast, radio, the Int~et:;:~r otlt~t m
inflated numbers, and do not double-count repeat attendees.
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•

Adults [number]

;:;:

•

Children [number]

•

Total [pre-fill]

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"Media" Arts Experience:
Provide an estimate:Qf
indivic;\ijl:IJ~:~xpected
to experience the project
.
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primarily through TV/cable, radio, the Internet,:~~nli,mobile prqgramming. Avoid inflated numbers,
and do not include people reached only t~~:,~d~~~~i~f~~~'
'\':<~"

•
•
•
•

Television [number]
Radio [number]
Internet [number]
Mobile [number]

•

Total [pre-fill]

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Project Activities:

pr~~~e your
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'";-X-;',,\

•

•
•

•

•
•

J estimates for each of the following categories

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# of professional
qualit:t,~lginal wol!:ks of art that will be created [number]
~i«~'~',
""";,,,<,>
- Include litera~'
rmt~, visual, multidisciplinary, and interdisciplinary works.
- Do no~'
de"
6rlts, adaptations, recreations, or restaging of existing works.
# of st '
rt t at will be created [number]
# qfJ
held [number]
::~i3:
",e"~~'a arts or film festivals. Report those activities below under "# of exhibitions
:tt~~ted/~,seri~~,d ."
# 6'~\Khibit~ns
to be curated/presented [number]
'\/"0
-lnciudet:~Jal arts, media arts, film, film festivals, and design. Count each curated film festival as a
single exl'fibition.
# of concerts/performances/readings [number]
# of lectures/demonstrations/workshops/symposiums [number]
',.''It,

International Activities
4

OMB Number: 0000-0000
Expiration Date: MM/DD/YYYY

TENTATIVE FUNDING RECOMMENDATION
Time remaining to finalize and submit this form: DD Days HH Hours
Applicant Name: [pre-fill] on behalf of: [only visible if independent component] [pre-fill]
NEA Application #: [pre-fill]
•

•

Will this project involve foreign artists or representatives of foreign institutions visiting the U.S.?
o Yes
• Country [drop down list]
• Number [number]
•
["add another country" button]
o No
Will this project involve U.S. artists or representatives visiting foreign
o Yes
• Country [drop down list]
• Number [number]
o

NO·

["add another country" button]

.

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Does this project have the potential to affect a building 50:~~,ars'~%ij:\~~lnd/or a historic
site? [single select]
",;~~,
~
• Yes
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o Provide the information necessary to reviEtw yo¢ur p~je~funder the National Environmental
Policy Act and/or the National Historic Pre~\rvation~:Kct.'(~OO character limit) [text]
•

NOH;:~'~;::\/}:
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Authorizing 0 ftj:~i;qr::;;;~:.::::,<:~:'~jli::::;:

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5