3135-0112 Our Town Grant Application Form

Blanket Justification for NEA Funding Application Guidelines and Reporting Requirements

Our Town Grant Application Form

Blanket Justification for NEA Funding Application Guidelines and Reporting Requirements for Nonprofit Organizations

OMB: 3135-0112

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3135-0112 can be found here:

Document [pdf]

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GAF
PLEASE DO NOT WORRY ABOUT FORMATTING AT THIS POINT -- IT'S JUST TO
HAVE THE GAF QUESTIONS TO WORK WITH

View Application Data
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The data below is from the application you submitted through Grants.gov. It is for
review only; this information cannot be edited here. If changes are needed, contact
[email protected].
Applicant Organization Name

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Organization Address

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Organization Address 2

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Applicant Organization City

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Applicant Organization State

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Organization Zipcode

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Organization Website

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Project Title

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Project Description
test test test

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Project Start Date

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Project End Date

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Project Director Prefix Name

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Project Director First Name

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Project Director Middle Name

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Project Director Last Name

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Project Director Title

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Part 1: Organizational Information
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See here for additional instructions:
o For Arts Engagement, Cultural Planning, and Design Projects:
http://arts.gov/sites/default/files/fy16-gaf-instructions-arts-engagement-planningdesign.pdf
o For Projects that Build Knowledge About Creative Placemaking:
http://arts.gov/sites/default/files/fy16-gaf-instructions-knowledge-building.pdf
OMB Number: 3135-0112
Expiration Date: 11/30/2016
NOTE: All red asterisked (*) items on this form are required and must be completed before you
will be able to submit the form.
Testing the OT GAF-kpw

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Applicant Legal Name (per your IRS Determination Letter): *

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Applicant Popular Name (if different):

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Date organization was incorporated (if applicable):

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Applicant Organization Status: Select the one item that best describes the legal status of the
organization *

08-17-2010

  Mission/purpose of your organization: Briefly summarize the mission and purpose of your
organization. For non-arts organizations (e.g., universities, human service agencies), summarize your
mission as it pertains to your creative placemaking activities. *

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 Organization Budget: Complete this section using figures from completed fiscal years. In the case of a
local government, limit this information to the department or office that will oversee the proposed
project.
See here for additional instructions:
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For Arts Engagement, Cultural Planning, and Design Projects:
http://arts.gov/sites/default/files/fy16-gaf-instructions-arts-engagement-planning-design.pdf
For Projects that Build Knowledge About Creative Placemaking:
http://arts.gov/sites/default/files/fy16-gaf-instructions-knowledge-building.pdf

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Most Recently Comple

Previous FY

Tw o FYs Prior

12/31/14

12/31/13

12/31/12

Earned

$ 100,000

$ 95,000

Contributed

$ 50,000

$ 75,000

$ 50,000

TOTAL INCOME

$ 150,000

$ 175,000

$ 145,000

Artistic Salaries

$ 50,000

$ 40,000

$ 25,000

Production / Exhibition

$ 10,000

$ 7,500

$ 5,000

Administrative Expens

$ 200,000

$ 150,000

$ 125,000

TOTAL EXPENSES

$ 260,000

$ 197,500

$ 155,000

Operating Surplus / D

($ 110,000 )

($ 22,500 )

($ 10,000 )

FY End Date (MM/DD/

Income

Expenses

 In the space below, discuss the fiscal health of your organization. In addition, 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). *

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 Applicant Organization Description: Select the primary description that is most relevant to your
organization and, optionally, up to two additional descriptions. *
  Applicant Organization Description: Optionally, choose up to two additional descriptions.
(To select more than one option on Windows, hold down the CTRL key and select multiple options.
To select more than one option on Mac, hold down the Command key and select multiple options.)

 Applicant Organization Discipline: Select the primary discipline that is most relevant to your
organization and, optionally, up to two additional disciplines. This refers to the primary artistic emphasis
of your organization. This selection will not be used in the review of your application. *
  Applicant Organization Discipline: Optionally, choose up to two additional disciplines.
(To select more than one option on Windows, hold down the CTRL key and select multiple options.
To select more than one option on Mac, hold down the Command key and select multiple options.)

 Primary Partner Legal Name (per your IRS Determination Letter) *

Partner?

 Primary Partner Popular Name (if different)

 Primary Partner's Taxpayer ID Number (9-digit number) *

 Date organization was incorporated (if applicable)

123456789

06-03-2015

 Primary Partner Organization Status: Select the one item that best describes the legal status of the
organization *
  Mission/purpose of partner organization: Briefly summarize the mission and purpose of your
primary partner's organization. For non-arts organizations (e.g., universities, human service agencies),
summarize your mission as it pertains to creative placemaking activities.

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 Primary Partner Proposed Role:
Briefly describe your primary partner organization’s involvement in planning and executing the project
including programming, management, finances, and any responsibilities for matching the National
Endowment for the Arts grant. Be specific; do not provide a general statement of support for the
project.

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 Primary Partner Organization Description: Select the primary description that is most relevant to
your primary partner's organization and, optionally, up to two additional descriptions. *

  Primary Partner Organization Description: Optionally, choose up to two additional
descriptions.
(To select more than one option on Windows, hold down the CTRL key and select multiple options.
To select more than one option on Mac, hold down the Command key and select multiple options.)

 Primary Partner Organization Discipline: Select the primary discipline that is most relevant to your
primary partner's organization and, optionally, up to two additional disciplines. This refers to the
primary artistic emphasis of your primary partner's organization. This selection will not be used in the
review of your application. *

  Primary Partner Organization Discipline: Optionally, choose up to two additional
disciplines.
(To select more than one option on Windows, hold down the CTRL key and select multiple
options.
To select more than one option on Mac, hold down the Command key and select multiple
options.)

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Part 2a: Project Information
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NEA Project Activity Category
Our Town Project Area: *

  Our Town Project Type: *
  Project Activity Type: *
  Additional Project Activity Type Optionally, choose up to two additional activity types.
(To select more than one option on Windows, hold down the CTRL key and select multiple options.
To select more than one option on Mac, hold down the Command key and select multiple options.)
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 Project Background and Context
See here for additional instructions:
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 Major Project Activities: Be as specific as possible about the activities that will take place during the
allowable project period. Where relevant, include information on any educational component or
outreach activities of the project. Do not describe organizational programming unrelated to the
proposed project.
See here for additional instructions:
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 Schedule of key project dates: Costs incurred prior to the earliest allowable start date (August 1,
2017) cannot be included in the project budget. If you include activities that occur before the earliest
allowable start date, make sure you note that those activities and costs are not included on the Project
Budget form. *

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 Accessibility: Explain how you will make your project accessible to individuals with disabilities in
compliance with federal law and regulations through access accommodations for both facilities and
programs, such as audio description, sign-language interpretation, closed or open captioning, large-print
brochures/labeling, etc. See the Nondiscrimination Statutes in "Assurance of Compliance" for more
information http://arts.gov/grants-organizations/our-town/award-administration. (For technical
assistance on how to make your project fully accessible, contact the Arts Endowment's Accessibility
Office at [email protected], 202/682-5532, or the Civil Rights Office at 202/682-5454 or 202/6825082 Voice/T.T.Y.) *

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Part 2b: Project Objectives
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Livability Narrative: Briefly discuss how your project will affect Livability: Strengthening
communities through the arts.
See here for additional instructions:
o

For Arts Engagement, Cultural Planning, and Design Projects:
http://arts.gov/sites/default/files/fy16-gaf-instructions-arts-engagement-planningdesign.pdf
For Projects that Build Knowledge About Creative Placemaking:
http://arts.gov/sites/default/files/fy16-gaf-instructions-knowledge-building.pdf

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 Performance Measurement: Briefly describe the performance measurements you will use to provide
evidence that the Livability objective was achieved, including plans for documenting and disseminating
the project results, as appropriate. If applicable, include the metrics or indicators that you will use to
identify and evaluate the project's short-term and long-term impact on your community's livability.
See the "Measuring Project Results" page on Exploring Our Town for help determining successful
measurements for your project: http://arts.gov/exploring-our-town/project-process/measuring-projectresults. *

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 Intended Beneficiaries (Audience/Participants/Community): Briefly describe the target community
to whom the project is directed. In your response, address the expected benefit. *

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 Have the intended beneficiaries been consulted in the development of this project? *
  Community Engagement: Describe substantive and meaningful engagement with the target
community in the development of the shared vision for your project and its implementation. Describe past
engagement or experience in working with the target community, as well as your plans for engaging the
community moving forward.

See here for additional instructions:
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Is this project intended to reach a population historically underserved by arts programming and/or does
the project target a specific audience based on characteristics such as race, ethnicity, or age? *
  From the options below, select all descriptors that best describe the intended audience and/or
other beneficiaries to whom the project is directed.
 Race/Ethnicity (choose all that apply):
(To select more than one option on Windows, hold down the CTRL key and select multiple options.
To select more than one option on Mac, hold down the Command key and select multiple options.)



Race/Ethnicity - U.S. federal government agencies must adhere to standards issued by the Office
of Management and Budget (OMB) in October 1997, which specify that race and Hispanic origin
(also known as ethnicity) are two separate and distinct concepts. These standards generally

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reflect a social definition of race and ethnicity recognized in this country, and they do not
conform to any biological, anthropological, or genetic criteria. Origin can be viewed as the
heritage, nationality group, lineage, or country of birth of the person or the person’s ancestors
before their arrival in the United States.
o American Indian or Alaskan Native - A person having origins in any of the original
peoples of North and South America (including Central America) and who maintains
tribal affiliation or community attachment.
o Asian - A person having origins in any of the original peoples of the Far East, Southeast
Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan,
Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
o Black or African American - A person having origins in any of the Black racial groups of
Africa.
o Hispanic or Latino - People who identify their origin as Hispanic, Latino, or Spanish may
be of any race.
o Native Hawaiian or Other Pacific Islander - A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
o White - A person having origins in any of the original peoples of Europe, the Middle East,
or North Africa.
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 Age Ranges (choose all that apply):
(To select more than one option on Windows, hold down the CTRL key and select multiple options.
To select more than one option on Mac, hold down the Command key and select multiple options.)

 Underserved/Distinct Groups (choose all that apply):
(To select more than one option on Windows, hold down the CTRL key and select multiple options.
To select more than one option on Mac, hold down the Command key and select multiple options.)
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 Describe how the project will benefit the underserved community.

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 Population for your Town/City/Tribal Land:

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Part 2c: Project Locations
Provide the city, state, and five-digit zip code in which project activities are expected to occur.
For international locations, provide the city, country, and enter "00000". You may submit
individual locations using the webform. To upload multiple locations at once, consider using
the multiple location spreadsheet upload option. You may submit up to 100 locations.
If you enter a location that can’t be validated, you will receive an option to “Save Anyway.”
Choose this and continue with your application.
Once entered (either one at a time or by using the spreadsheet upload option) you will be able
to review your entries on the bottom of this page, and make revisions. You can make changes
in an entry or move to another entry by clicking the Edit button for that entry.
Add project locations one at a time
City *

State *
Zip Code *

Upload project locations from a spreadsheet

Use the project location template to list your projects and upload a single
spreadsheet. The system will validate whether the data is in the correct format. For a smooth
upload process, please abide to the formatting for each data type. » Download the project
location template

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Part 3: Project Budget
Flip so Expenses fields come before Income fields
Edit field title TOTAL MATCH to TOTAL COST SHARE/MATCH




Budget descriptor fields with more than 100 characters will be truncated when reviewed by
panelists.
See here for additional instructions:
o For Arts Engagement, Cultural Planning, and Design Projects:
http://arts.gov/sites/default/files/fy16-gaf-instructions-arts-engagement-planningdesign.pdf
o For Projects that Build Knowledge About Creative Placemaking:
http://arts.gov/sites/default/files/fy16-gaf-instructions-knowledge-building.pdf
Income

1. Amount Requested

$ 150,000

2. Total Match for this

Cash

Cash Amount

Other grants

$ 75,000

donations

$ 25,000

tickets

$ 15,000

other

$ 25,000

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Total cash (a):

$ 140,000

In-kind

In-kind Amount

supplies

$ 5,000

photographer

$ 5,000

Total In-Kind (b):

$ 10,000

Total match for this pr

$ 150,000

3. Total project incom

$ 300,000

Expenses

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1. Direct Costs: Salar

TITLE AND/OR TYPE O NUMBER OF PERSON ANNUAL OR AVERAG % OF TIME DEVOTED AMOUNT

Project Director

100000

$ 50,000

Gopher

10000

$ 5,000

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Total Salaries and w a

$ 55,000

Fringe Benefits

Total fringe benefits (

Total salaries and frin $ 55,000

2. Direct Costs: Trave

# OF TRAVELERS

FROM

AMOUNT

Here

There

$ 2,500

There

Here

$ 2,500

Here

Back Again

$ 1,000

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Total Travel

$ 6,000

3. Direct Costs: Other

AMOUNT

This

$ 64,000

That

$ 75,000

The Other

$ 100,000

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Total other expenses

$ 239,000

4. Total Direct Costs (

$ 300,000

5. Indirect Costs (if ap

Federal Agency:

Rate (.0000):

Base:

Total Indirect Costs

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6. Total Project Costs

Must equal
Total Project
Income (3.
From Income
budget table
above)

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$ 300,000.00

The amounts below will populate from what you have entered after clicking Save at the
bottom. If you included an Indirect Cost Rate, the figures may not exactly match. In this case,
click Save and continue.
Total Project Income MUST equal Total Project Costs.
If they do not equal, you must adjust your figures in your budget above and Save.



Amount Requested from the NEA (1)

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Total Match (2a 2b)

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TOTAL PROJECT INCOME (3)

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TOTAL PROJECT COSTS (4 5)

$ 150,000

$ 300,000

Part 4a: Project Participants - Individuals
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Selection of Key Individuals: Briefly describe the process and criteria for the selection of key
staff, consultants, advisors, artists, designers – anyone who will be a key contributor to the
success of your proposed project, regardless of their organizational affiliation -- that will be
involved in this project . Where relevant, describe their involvement in the development of the
project to date. Where they remain to be selected, describe the procedures that you plan to
follow and the qualifications that you seek. *
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 Bios of Key Individuals: Include brief, current biographies of the key individuals. You may include up
to 10.
 First Name

 Last Name (use this field for artistic group names or single names)

 Title

 Project Role
 Proposed or committed?
  Bio

Part 4b: Project Participants - Organizations
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Other Organizational Partners: An organizational partner is an outside entity that will provide
resources (other than money) to support the project. Because all NEA projects require
matching resources from non-NEA sources, organizations that only provide money are not
considered partners. Funders are not excluded from being partners, but they must also supply
human resources or information capital, or actively participate in another way. If applicable,
briefly describe the process and criteria for the selection of key organizations that will be
involved in the project. Where relevant, describe their involvement in the development of the
project to date. Where they remain to be selected, describe the selection procedures that you
plan to follow and the qualifications that you seek.

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 Description of Other Organizational Partners: Include brief, current descriptions of the key
organizational partners. You may include up to 10.
 Organization Name

Anonymouse

 Proposed or committed?
  Organization Type
  Description of the Organization Role in Proposed Project

6 characters remain

Part 4c: Project Participants - Works of Art
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Selection and Description of Key Works of Art:
See here for additional instructions:
o For Arts Engagement, Cultural Planning, and Design Projects:
http://arts.gov/sites/default/files/fy16-gaf-instructions-arts-engagement-planningdesign.pdf
o For Projects that Build Knowledge About Creative Placemaking:
http://arts.gov/sites/default/files/fy16-gaf-instructions-knowledge-building.pdf
o

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Part 5a: Programmatic Activities

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Lead Applicant Programmatic Activities
Submit representative examples of your programmatic activities for the past three
years/seasons (up to 5 examples per year/season). While the headings may not fit in every
case, use these spaces to demonstrate what your organization has done for the last three
years. Note: You can't change the years/seasons. If you need to provide information for
different years/seasons, please note the years you are using in the "Programmatic Activity
notes" section below.
These examples should demonstrate eligibility (i.e., your organization's three-year history of
programming) and the artistic excellence and merit of your organization. This section must
show the eligibility of the Lead Applicant; however, if applicable you may also show activities
undertaken by the Primary Partner as well.

FIELDS BELOW ARE REPEATED FOR THREE YEARS, FIVE EXAMPLES PER YEAR

 Year/Season

2013/2013-14

 Title/Work/Program

200 characters remain

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 Key Artists/Personnel

200 characters remain

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Location

 # of classes, performances, exhibitions, residencies, etc.
 # of participants or audience
 Fees (was Touring Info. on other GAFs)

200 characters remain
Programmatic Activity notes:
Provide any notes about your programmatic activity.

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Part 5b: Items to Upload
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Upload your work samples and statements of support here.
See here for additional instructions:
o For Arts Engagement, Cultural Planning, and Design Projects:
http://arts.gov/sites/default/files/fy16-gaf-instructions-arts-engagement-planningdesign.pdf
o For Projects that Build Knowledge About Creative Placemaking:
http://arts.gov/sites/default/files/fy16-gaf-instructions-knowledge-building.pdf

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Panelists will not review more than 20 minutes of work samples.

Upload files here. DO NOT click the Manage Folders button. Simply click Upload and
reorder or edit your files if necessary.

 Be sure to click Save before clicking Submit.
You must click Submit to finalize your application for NEA review.

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Don't forget to hit the "Submit" button when you are ready to submit your application. If you do not hit
the "Submit" button, your application will not be received.
You will receive confirmation of your successful submission in two ways: 1) a pop up on your screen, and
2) an email from [email protected]. Maintain documentation of your successful submission
(take a screenshot and/or keep the email). If you modify your application after you submit, you will not
receive additional confirmations.

You also can confirm that your application was received when you log in to NEA-GO. On the first screen
it will say “Received” if your application has been received. If your application has not yet been received,
it will say “In Progress.”

File Type	application/pdf
Author	Jillian Miller
File Modified	2016-08-22
File Created	2016-08-22