3135-0112 Research Grant Application Form

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Research: Art Works, FY 2017

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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
the National Endowment for the Arts.
Applicant Organization Name
TEST Organization name

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Organization Address
TEST 123 Street Address

TEST Suite 123

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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 Start Date

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Project End Date

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Project Director Prefix

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Project Director First Name

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Project Director Middle Name

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Project Director Last Name

TEST Any Tow n

TEST State

TEST 12345

TEST w ebsite URL

01-01-2016

12-01-2015

TEST

TEST

TEST

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Research: Art Works, FY 2017

Project Director Title

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Part 1a: Organizational Information
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Please refer to our website for instructions on how to fill out the Grant Application Form, as well
as what items to upload, in "Step 2: Submit Materials to NEA-GO." See here for more
information: http://arts.gov/sites/default/files/nea-grant-application-form-instructionsresearch.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.
Anonymous

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Legal Name (per your IRS Determination Letter): *

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Popular Name (if different):

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For this application, are you serving as the Parent of an Independent Component: *

Anon

    Mission of your organization: Briefly summarize the mission of your organization. For non-arts
organizations (e.g., universities, human service agencies), summarize your mission as it pertains to your
cultural programs or services. *

500 characters
Briefly summarize the background/history of your organization. *

1000 characters remain
 Organization Budget: Complete this section using figures from completed fiscal years. If you are a
parent organization, this information should refer to the component on whose behalf you are applying.
Please see the instructions for filling out the Organization Budget in "Step 2: Submit Materials to NEAGO." See here for more information: http://arts.gov/sites/default/files/nea-grant-application-forminstructions-research.pdf

FY End Date (MM/DD/

Most Recently Comple

Previous FY

Tw o FYs Prior

9/30/2015

9/30/2014

9/30/2013

$ 50,000

$ 40,000

$ 30,000

Income

Earned

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Contributed

$ 10,000

$ 20,000

$ 30,000

TOTAL INCOME

$ 60,000

$ 60,000

$ 60,000

Artistic Salaries

$ 15,000

$ 10,000

$ 5,000

Production / Exhibition

$ 75,000

$ 50,000

$ 25,000

Administrative Expens

$ 100,000

$ 75,000

$ 50,000

TOTAL EXPENSES

$ 190,000

$ 135,000

$ 80,000

Operating Surplus / D

($ 130,000 )

($ 75,000 )

($ 20,000 )

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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117 characters remain

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Part 1b: Operating History List
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Operating History
Submit representative examples of your organization’s operating history for the past three
years.
These examples should demonstrate eligibility (i.e., your organization's three-year operating
history) and the artistic excellence and merit of your organization. Where applicable, include
research/evaluation programming that has a relationship to the project for which you are
requesting.

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Year 1

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Representative examples: REQUIRED FIELD

REQUIRED FIELD 10 CHARACTERS

3,500 characters remain

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Year 2

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Representative examples: REQUIRED FIELD

3,500 characters remain

REQUIRED FIELD 10 CHARACTERS

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Research: Art Works, FY 2017

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Year 3

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Representative examples: REQUIRED FIELD

REQUIRED FIELD 10 CHARACTERS

3,500 characters remain

Operating History notes:
Provide any notes about your operating history.

1000 characters remain

Part 2: Project Information
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NEA Project Activity Category (SINGLE SELECT)

Track One (Value and Impact)
Track Two (Experimental and Quasi-Experimental Designs)

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Research: Art Works, FY 2017

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Artistic Discipline for Proposed Project: This refers to the artistic discipline associated with
your project. Please choose the artistic disciplines that best fits your research project [single
select]. *

  Project Activities

 Project Title
If your project title has changed since you submitted through Grants.gov, provide a new project
title in the text field below. Text cannot be formatted (e.g., bold, italics). If you have no changes,
leave the text as is (e.g., do not type "N/A").
N/A

 Project Description
If your project description has changed since you submitted through Grants.gov, provide a new
description in the text field below. Text cannot be formatted (e.g., bold, italics). If you have no changes,
leave the text as is (e.g., do not type "N/A").

1000 characters remain

 Major Project Activities: Please see the Research: Art Works guidelines for detailed instructions
here: http://arts.gov/sites/default/files/nea-grant-application-form-instructions-research.pdf Be as specific
as possible about the activities that will take place during the project period. Please organize your
response a), b), c), etc. and use the boldfaced language in the instructions as a heading for each item.
(30,000 character limit) [text box]
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21584 characters remain

 Data Management Plan (5,000 character limit) [text box] *
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3448 characters remain

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 Descriptions (e.g., abstracts) about relevant prior research. (5,000 character limit) [text box] *
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52 characters remain

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-federal 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.

 Description of Key Organizational Partners: Include brief, current descriptions of the key
organizational partners. You may include up to 10.
 Organization Name
 Proposed or committed?
  Description of the Organization
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*

 Bios of Key Individuals: Include brief, current biographies of the key individuals. You may
include up to 5.
 First Name
 Last Name (use this field for artistic group names or single names)
 Proposed or committed?
  Bio Briefly describe the qualifications, roles, responsibilities, and percent of time to be devoted to
the project for key personnel. Identify if the personnel will be involved with human subjects research
and/or human subjects data (certificates of training in ethics for human research are requested as a
separate item). Please include, as appropriate: education; professional experience and honors; selected
peer-review and non-peer review publications, including manuscripts in preparation or under review;
history of ongoing and completed research support, including sources of support; and research skills.
Include affiliations within the past year and through the following year.

1000 characters remain

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 Schedule of key project dates: Describe the significant dates in the project. Costs incurred prior to
May 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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1493 characters remain

 Promotion & Publicity: Provide plans for making all related research papers, presentations, and
products accessible to the public, including use of various distribution channels and modes. Describe
partnerships, if any, for distributing the results. For projects that include the development of new arts
interventions and/or research tools or models, please describe the potential scalability and translational
ability of the project. *
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986 characters remain

 Accessibility:
Federal regulations require that all NEA-funded projects be accessible to people with disabilities. Funded
activities must be held in an accessible venue and program access and effective communication must be
provided for participants and audience members with disabilities. If your project is recommended for
funding, you will be asked to provide information describing how you will make your project physically and
programmatically accessible to people with disabilities:
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

Buildings and facilities (including projects held in historic facilities), should be physically
accessible. This includes, but is not limited to: ground-level entry, ramped access, and/or
elevators to the venue; integrated and dispersed wheelchair seating in assembly areas;
wheelchair-accessible box office, stage, and dressing rooms; wheelchair-accessible display
cases, exhibit areas, and counters; and wheelchair-accessible restrooms and water fountains.
The programmatic offering should be accessible either as part of the funded activity or upon
request, where relevant. This can include, but is not limited to: contact information for requesting
accommodations; electronic materials and websites; print materials in alternative formats, such
as large-print brochures/labels, Braille, and electronic/digital formats; accommodations for
performance, tours, and lectures, such as audio description, tactile opportunities, sign language
interpretation, and real-time captioning; closed/open captioning of video and film; and assistive
listening devices.

Please see the Nondiscrimination Statutes in our "Assurance of Compliance" for additional information.
For technical assistance on how to make your project fully accessible, contact the Accessibility Office at
[email protected], 202/682-5532 Voice or the Civil Rights Office at 202/682-5454 or 202/682-5082
Voice/T.T.Y., or see our online Accessibility Resources.
Will your project be accessible to people with disabilities, inclusive of physical and programmatic access
for those with physical, hearing, vision, and cognitive disabilities?
Y/N

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46 characters remain

 Performance Measurement: How will you measure the success of your project? Describe any plans
you have for program evaluation, for working collaboratively with researchers, strategic consultants,
program evaluators, and/or any other plans for performance measurement related to the project. (1000
character limit) [text box]
Please see "Program Evaluation Resources" (http://arts.gov/grants-organizations/art-works/programevaluation-resources) for additional information. *
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46 characters remain

 Intended Audience/Participants/Community
 Who will benefit from the project and how? *
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2000 characters remain

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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

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Please see the instructions for filling out the Project Budget in "Step 2: Submit Materials to
NEA-GO." Budget descriptor fields with more than 100 characters will be truncated when
reviewed by panelists.. See here for more information: http://arts.gov/sites/default/files/neagrant-application-form-instructions-research.pdf
Income
1. Amount Requested

$ 100,000

2. Total Match for this

Cash

Cash Amount

donations

$ 10,000

$ 110,000
other grants

Be as specific as possible. Asterisk (*) those funds that are
committed or secured.
university endow men

$ 40,000

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Research: Art Works, FY 2017

Total cash (a):

$ 160,000

In-kind

In-kind Amount

research staff salarie

$ 50,000

university supplies

$ 5,000

Total In-Kind (b):

$ 55,000

Total match for this pr

$ 215,000

3. Total project incom

$ 315,000

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Expenses
1. Direct Costs: Salar

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

research faculty

2

50000

50%

$ 50,000

statistician

2

50000

25%

$ 25,000

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Total Salaries and w a

$ 75,000

Fringe Benefits

Total fringe benefits (

Total salaries and frin $ 75,000

2. Direct Costs: Trave

# OF TRAVELERS

FROM

TO

AMOUNT

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3 research conferenc here

Total Travel

there

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$ 5,000

$ 5,000

3. Direct Costs: Other AMOUNT

survey design

$ 50,000

other stuff

$ 100,000

more stuff

$ 75,000

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miscellaneous

$ 10,000

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Total other expenses

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$ 235,000

4. Total Direct Costs ( $ 315,000

5. Indirect Costs (if ap

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

Federal Agency:

HHS

Rate (.0000):

.5

Base:

$ 315,000

Total Indirect Costs

$ 157,500.00

6. Total Project Costs

$ 472,500.00

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.

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Research: Art Works, FY 2017

If they do not equal, you must adjust your figures in your budget above and Save.
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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)

$ 100,000

$ 215,000

$ 315,000

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Part 4: Upload Docs, Work Samples

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There are two types of required items to upload: Human ethics certificates and permission to
collect/use data (including IRB documentation). An attachment of supplementary materials
related to data collection and analysis, outside of the required documentation above, is optional.
Please refer to the NEA's website for instructions for documents to upload in "Step 2: Submit
Through NEA-GO." See here for more information: http://arts.gov/sites/default/files/nea-grantapplication-form-instructions-research.pdf.
You must click Submit to finalize your application for NEA review.

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

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Part 5: Organization and Project Profile


The National Endowment for the Arts collects basic descriptive information about all applicants
and their projects. The information that follows will help the NEA to comply with government
reporting requirements, and will be used to develop statistical information about the
organizations and projects it funds to report to Congress and the public. Your responses will not
be a factor in the review of your application.



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.
See Part 2: Project Information: NEA Discipline to choose the discipline that you would like to
review your project. *

  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.)

 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.)

 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.)

 Audience/Participants/Communities
If known, select all descriptors that best describe the intended audience/participants/communities that the
project aims to reach.
 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
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.

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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.
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.
Black or African American - A person having origins in any of the Black racial groups of
Africa.
Hispanic or Latino - People who identify their origin as Hispanic, Latino, or Spanish may
be of any race.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
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.)


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