ArtsGreensboro

Interim Grant Report Form: FY2016 Project Support

ArtsGreensboro

Project Support

INTERIM REPORT

Due April 1, 2016, for FY16 Projects not yet completed

Funded in part by the North Carolina Arts Council

Mailing Address

PO Box 877

Greensboro, NC 27402

Street Address

200 North Davie Street, Suite 201

Greensboro, NC 27401

336.373.7523, ext 243(phone)

336-373-7553 (fax)

(email)


ArtsGreensboroInterim Report for Project Support Grants

General Information

The purpose of this report is to obtain information on the use of ArtsGreensboro (AG)funds during FY2016for projects not yet completed. This form should only be used if you are applying for funding from ArtsGreensboro for an FY2017 project, but have not yet completed an FY2016project funded by ArtsGreensboro.

Recipient Data Sheet

(Must be typed)

Name ofRecipient

Contact Person’s Name Title

Mailing Address

City State Zip Code

Work Phone Home PhoneFax Number

E-mail Address Web Address

Grant Information

Amount received from ArtsGreensboro for project $

For the project funded by ArtsGreensboro:

Total Cash Income $ Total Cash Expenses $

Program Start Date Expected completion Date

Please provide the date of your fiscal year-end:

Recipient Name:

Income & Expense Actuals (To date)

Provide income and expense actuals to date, using the format below. See definitions of terms in sidebar on right.

Income
Earned Revenue
Admissions
Contracted Services
Other: Describe
Contributed Revenue
Private Support
Corporate
Individual
Foundation
Other Private: Describe
Public Support
Federal
State
County
City
In-kind
ArtsGreensboroGrant Investment Received
TOTAL INCOME
Expenses / Organization Funds Spent / AG Funds Spent
Personnel
Administrative Staff
Artistic Staff
Technical/Production Staff
Outside Fees & Services
Artistic Contracts
Other Contracts: (describe)
Supplies
Space Rental
Utilities
Travel
Marketing
Fundraising
Maintenance
In-Kind
Capital
Remaining Expenses:(describe)
TOTAL EXPENSE

FY2016Employee & Participation Statistics

Number of Full-Time Employees: # of Part Time-Employees: # of Contract Employees:

Total (estimated) number of artists under contract in FY16:

(All disciplines. May also be included in the number of employees above.)

Number of Board Members:

Estimated number of FY16 audience/participants for all arts programs and activities:

Estimate the percentage of those served by your organization who are:

Seniors Veterans Women Disabled Students on Free or Reduced Lunch

Breakdown of audience/participants for all arts programs and activities, by ethnicity (below):

# African American / # Asian American / # Latino / # Native American / # White / # Pacific Islander / Total #
must equal numbers above
Employees
Board members
Audience/Participants
Participating Artists
Youth (preK-12)

Were 50% or more of the activities arts in education? YES No

Total # of volunteers working with your organization in FY16: Total # of (estimated) hours:

FY2015(Last year) / FY2016(Current year) / FY2017(Next year)
Actual Income $ / Projected Income $ / Projected Income $
Actual Expense $ / Projected Expense $ / Projected Expense $

Narrative

Attach a narrative evaluation of your funded project (maximum of2 pages, minimum 10 point font, single-spaced), addressing the following items, in order.

  1. Specifically describe how ArtsGreensboro investment was used and provide detailed information on how this program supported and advanced one or more of ArtsGreensboro’s three strategic priorities:
  • ACCESS –Increase community access to the arts, and ensure the rich diversity, sustainability, and growth of arts resources.
  • ECONOMIC VITALITY – Support economic vitality and position Greensboro as a cultural destination by recognizing innovation and excellence in creativity.
  • ARTS EDUCATION – Foster life-long learning in and through the arts.
  1. Outline any changes that have been made to the original proposed program of work, state why these changes were made, and demonstrate how you plan to meet your objectives.
  1. Define how you intend to measure outcomes of your program of work.
  1. Describe any multicultural programming presented with this funding and give the amount spent. Multicultural programs are those in which the majority of artists involved are African American, Asian American, Latino, and/or Native American.
  1. Describe how professional artists and arts organizations were involved in the use of this grant investment.
Interim Report Certification

MUST BE ON RECIPIENT’S LETTERHEAD

On your letterhead, provide the following information:

  1. Recipient Name
  2. Date
  3. I/We certify that the foregoing report, including attachments and supporting materials, is true, accurate and complete to the best of our knowledge and that the expenditures are for the purposes set forth in the grant award documents.
  4. Name and Position of Authorizing Official
  5. Signature of Authorizing Official and date of signature. Fiscal Agent, if used, should be listed as authorizing official.
  1. Name and Position of Contact Person
  2. Signature of Contact Person and date of signature

Organizational recipients must also provide the following:

  1. Name of Board Chair
  2. Signature of Board Chair and date of signature
  3. Name of Treasurer
  4. Signature of Treasurer and date of signature

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