Organizations Boilerplate 10

Please do not staple any materials together MAINE ARTS COMMISSION 193 State Street 25 State House Station Augusta, ME 04333-0025 207/287-2724 Main Line 877/887-3878 TTY/NexTalk APPLICATION FORM: ORGANIZATIONS Fax copies, email copies, or incomplete applications will not be accepted Please type or reformat in word processing Please check the appropriate grant program ARTS IN EDUCATION  SMART: Schools Make Arts Relevant Today COMMUNITY ARTS DEVELOPMENT  BUILDING CAPACITY IN MAINE’S CULTURAL COMMUNITIES DISCOVERY RESEARCH SUSTAINING TRADITIONAL ARTS IN THE COMMUNITY ORGANIZATIONS AND INSTITUTIONS AMERICAN MASTERPIECES VISUAL ARTS PROJECTS ARTISTS IN MAINE COMMUNITIES CULTURAL FACILITIES ACCESSIBILITY SPECIAL PROJECTS Name of Applicant Organization ______________________________________________ Contact person ___________________________Title _____________________________ Address __________________________________________________________________ City ___________________________County ________________State ____Zip ________ Telephone _______________ Fax_____________TTY/TDD _______________________ E-mail _______________________________Website _____________________________ Federal tax ID #_____________________________ Grant Request $________________ Primary artistic discipline of the applicant or project _____________________________ Please provide a short sentence or a title that describes the project. _________________________________________________________________________ _______________________________________________________________________

Project start date____________________ Project end date__________________________

ASSURANCES FORM The Applicant Hereby Assures the Maine Arts Commission That: 1. The activities and services for which assistance is sought will be administered by or under the supervision of the applicant. 2. Any funds received under this grant shall not be used to supplant funds normally budgeted for services of the same type. 3. The applicant will assure that it will credit Maine Arts Commission in all publicity regarding the project. The following credit line must be used with all advertising, promotion, and other publicity and presented orally at events at which no printed program in used: Funded in part by a grant from the Maine Arts Commission, an independent state agency supported by the National Endowment for the Arts. The Maine Arts Commission logo, which can be downloaded at www.MaineArts.com/news/logos/index.shtml, must be used in printed materials related to this initiative. 4. The applicant and any organization assisted by it will comply with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973 as amended, the Americans with Disabilities Act of 1991, and the Age Discrimination Act of 1975 which bars discrimination in federallyassisted projects on the basis of race, color, national origin, age, handicap or sex. The Maine Arts Commission further bars discrimination on the basis of sexual orientation. 5. In compliance with the Americans with Disabilities Act, All programs funded by the Maine Arts Commission must be programmatically accessible and held in accessible spaces. 6. The applicant will comply with the Drug-Free Workplace Act of 1988. The applicant and any organization assisted by it will comply with sections 5(j) and 5(k) of U.S. Public Law 89-209 in regard to the employment of professional personnel, mechanics and laborers employed for any construction project, and the health, safety and sanitary laws of the state. The applicant will give such assurance to the U.S. Secretary of Labor upon request.

7. Any organization that receives $25,000 or more in federal funds during a given fiscal year is required to maintain personnel activity reports for any employee whose salary is charged, in whole or in part, to either the award or the matching funds. A sample form is available from the Maine Arts Commission office. The results of this audit must be reported to the Maine Arts Commission within 13 months of the completion of the grant period and kept on file at the Maine Arts Commission office.

8. The applicant will comply with 18 U.S.C. Sec. 1913 regulating lobbying with appropriated moneys and with the Hatch Act (5 U.S.C. Sec. 15011508 and 7324-7328) which limits the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. The applicant will maintain an adequate financial management system to provide efficient and effective accountability and control of all property, funds and assets in compliance with OMB Circulars A-102, A128 (for local governments) and A-110 (for nonprofit organizations and universities). These circulars are on file at the Maine Arts Commission office for your information. 10. All grantees must enter or update demographic information as a participant of: The Maine Arts Commission’s Artists and Organizations Directory, http://www.MaineArts.com/directory/index.shtml and the New England Cultural database at www.newenglandarts. I, ______________________________ (printed name of authorizing official) have been authorized to sign this compliance form on behalf of the applicant, and otherwise act as the authorized representative of the applicant in connection with its application to the Maine Arts Commission, and do hereby give assurances to the Maine Arts Commission that the organization I represent will comply with the above federal regulations. If a public school or district is the applicant, the authorizing official must be the principal or superintendent. Signature of authorizing official. This individual must be the same person listed as contact on the application form and Maine State Vendor Form ________________________________________________________________________ Title of authorizing official __________________________________

Date ________________

BUDGET FORM Please itemize the costs of your initiative in the spaces below. For instance, if you are paying consultants or others with grant funds, describe who they are, and show how the cost is to be split between the grant and the applicant. You may match a grant with cash or the value of in-kind (noncash) contributions to your project. Compute in-kind contributions by estimating what it would cost you or your organization if you had to purchase the material or services being donated. The total values in columns D and E must be equal or greater to the amount you request (column C). If your project’s expenses fall into categories not shown below, please detail them under “other.” If you have questions, please contact Kathy Ann Shaw, 207/287-2750 or [email protected]. A. Category

B. Budget Item

C. This Grant

D. Source of Match: Applicant’ s cash

E. Source of Match: Applicant’ s in-kind

F. TOTAL

1. Salaries & Fees

Administrati on, consultants, etc.

2. Space

Office & Meeting Space Postage

3. Communicati ons

Phone Printing Duplication

4. Travel

Mileage, Tolls, Etc.

5. Other

TOTAL What portion of this total is paid directly to artists _________ Please estimate the number to be served by this project: Categories that are not relevant to your project may be left blank. TOTAL individuals must be a numerical number. Artists ____ Teachers ____ Students/Youth ____ TOTAL number of individuals ____

HOW TO COMPLETE THE BUDGET FORM On a separate page, please provide descriptions of the items in the budget as well as any additional details, especially information on sources and amounts of other anticipated income, anticipated revenues from ticket sales, etc. COST-SHARING Total costs for any project must be shared between the amount of the grant and the applicant. Applicants can meet this requirement in one of three ways: 1) by applying cash to the project, including gifts, grants, salaries,

fees, etc; 2) by estimating in-kind (non-cash) contributions to the project; or 3) by combining cash and in-kind values in their cost share. The total amount of cost share should at least equal the amount of the grant being applied for. SALARIES & FEES This can include the leader, coordinator, artists or other individuals overseeing the project. Please figure percentage of time devoted to project and reasonable hourly, daily, or flat rate. We normally cannot pay for general operating expenses such as salaries for your organization’ s staff, although in many small projects, these services are used as either cash or inkind cost share. Consultants can include scholars, writers, folklorists, performers, researchers or any other specialists needed to pursue the project. Compensation can be figured on an hourly basis or a flat fee. SPACE Applicants normally include the value of office and meeting space as part of their in-kind contribution. (example, office space used for project 25% of time for six months at a rental rate of $100/month = $150.00). EQUIPMENT USE & MATERIALS Materials are things that will be used up in the course of the project, like computer disks, paper, paper clips, tape, etc. Equipment use is the cost of using equipment that may need to be rented for the project. COMMUNICATIONS & PUBLICITY In each area describe as precisely as possible. Compute estimated cost of telephone calls for your project, postage and printing by estimate based on size of audience. TRAVEL Necessary travel expenses for key participants can include economy air and ground transportation and incidentals such as parking and tolls (figure auto mileage at 42¢ mile). You may also include a portion of the cost of lodging for key project personnel who must travel as part of the project. We cannot reimburse the cost of liquor or entertainment.