Contact Information:
Address:
Name:
Organization:
City:
State:
Zip:
Email:
Person to contact regarding this application:
Evening Phone:
Daytime Phone: 
Email:
Project Information:
Project Name:
Project Description:
If you are collaborating with partners, please include who they are and describe their roles within your program/project. Be as specific as possible.
Please limit to 500 words or less
Project Goals & Objectives: Please limit to 500 words or less
Estimated Start Date:
Estimated Completion Date:
Ongoing Program:
If Yes, please describe:
Target Audience & Expected Reach: Please limit to 500 words or less
 What impact will your project have on the community? Please limit to 500 words or less
Outline any promotional plans you have during the project and/or upon completion:
Please limit to 500 words or less
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Are you applying for funding of the same project that was previously awarded ArtSeed funding?   If so, how do you plan to grow and develop the project for which funds are being requested?  Please limit to 500 words or less
RAC ARTSEED FUNDS REQUESTED (Select One):
NOTE: Applicant must match the grant request at least 1:1 in either cash, in-kind services or a combination of both.
How Do You Plan to Use the RAC ArtSeed Funds?   Please limit to 500 words or less
Outside Fees & Services:

Budget:
Administrative

Artistic

Technical Production

Applicant's/Organization's Personnel:

Other

Administrative

Artistic

Technical Production

Other

Space Rental:

Travel:

Marketing:

Remaining Operating Expenses:

TOTAL RAC ARTSEED  FUNDS REQUESTED
Amount should match the amount selected above

Briefly Describe Planned Use Of Matching Funds

MATCHING FUNDS

RAC ARTSEED FUNDS


CASH

IN-KIND

TOTAL MATCH CASH

TOTAL IN-KIND CONTRIBUTIONS

Organizational Assurances:
The applicant HEREBY ASSURES THAT:

The activities and services for which assistance is sought will be administered by or under the supervision of the applicant. 

A. It will comply with Title VI of the Civil Rights Acts of 1964 (42 U.S.C.
2000d et seq.); where applicable, Title IX of the Education Amendments
of 1972 (20 U.S.C. 1681 et seq.); and all regulations of the National Endowment for the Arts. Title VI, Section 504 and Title IX prohibit discrimination on the basis of race, color, national origin, handicap, or sex in any program or activity receiving federal assistance. The applicant HEREBY GIVES ASSURANCE that
it immediately will take any measures necessary to comply.

B. It will comply with Section 5 (j) of the National Foundation on the Arts and Humanities Act of 1965 U.S.C. 954 (j). Section 5 (j) provides that:

(a) All professional performers and related, or supporting professional personnel employed on projects or productions which are financed in whole or in part under this grant will be paid without subsequent deductions or rebate on any account, not less than the minimum compensation for persons employed in similar activities, and

(b) No part of any project or production which is financed in whole or part under this grant will be performed or engaged in under working conditions which are unsanitary or hazardous or dangerous to the health and safety of the employees in such project or production. Compliance with the safety and sanitary laws of the State of Wisconsin shall be prima facie evidence of compliance.

C. It will comply with the laws of 1981, Chapter 112, of the State of Wisconsin which require agencies contracting with the State of Wisconsin not to discriminate against any employee or applicant for employment because of age, race, religion, color, handicap, sex, physical condition, or developmental disability as defined in S. 51.05 (5), sexual orientation, or national origin. These laws place specific obligations for affirmative action upon grant recipients of the State. The applicant HEREBY GIVES ASSURANCE that it will immediately take any measures necessary to comply.

The filing of this application has been authorized by the governing board of the applicant.

Funds received as a result of this application will be expended solely on the described projects and as represented.

The figures, facts, and representations made in this application, including all exhibits and attachments, are true and correct to the best of the applicant’s knowledge and belief.
 
These assurances are given in connection with any and all financial assistance received from the Racine Arts Council after the date this form is signed. The applicant recognizes and agrees that any such assistance will be extended in reliance on the representations and agreements made in this assurance, and that the United States, the State of Wisconsin, or both shall have the right to seek judicial enforcement for these assurances. These assurances are binding on the applicant, its successors, transferees, and on the official whose signature appears below.

I Agree To These Organizational Assurances

Organization:
Applicant Status (Select One)
Name of Authorizing Official:
Does your proposed project/program occur primarily within Racine County? 
If Yes, please identify locations:

Please review the ArtSeed Grant Criteria carefully before submitting your application.
No Yes
$500
$1,000
$1,500
Yes
Individual
501(c)3
Non 501(c)3 with Fiscal Receiver (list Fiscal Receiver)
Public or Private School
No Yes