COMMUNITY FUND

Application

NATIONAL PERFORMANCE NETWORK

Winter Fiscal Year 2005

DEADLINE: January 24, 2005

(1) Fill out application on computer (2) Email to:

(3) The National Office will email out a list of all applications received. Make sure that your application is on this list.

NPN Partner: / Contact:
Street: / Title:
City: / Phone:
State, Zip: / Email
Artist: / Contact:
Street: / Title:
City: / Phone:
State, Zip: / Email
Collab Org (if any): / Contact:
Street: / Title:
City: / Phone:
State, Zip: / Email
Project Title
Discipline / CHOOSE ONEDanceMulti-disciplineMusicTheaterPerformance ArtPuppetrySpoken Word /

Project Dates: (MM/DD/YY)

From / To
Project Summary
(keep it simple and concise)
Project Objectives
(Give brief project objectives)
Project Expenses: $ / Project Income
(a)  Request from NPN (up to $6,000): $
(b)  From Other Sources (cash only): $ $


Project Description (+ 500 Words)

NOTE: Include a description of the activities, project goals, the background of the participants, the process to be used and an evaluation plan. Remember to include a plan for crediting NPN.

RELATED RESIDENCY AND CREATION FUND DATES

From
(MM/DD/YY)
/ To
(MM/DD/YY)
NPN Residency
NPN Creation Fund (if Applicable)

PROJECT TIMELINE

From
(MM/DD/YY)
/ To
(MM/DD/YY) / ACTIVITIES
(e.g. Planning Meetings, Workshops, etc.) /
PARTICIPANTS

PROJECT BUDGET

These costs should NOT include NPN Residency or Creation Fund costs. The amounts should reflect costs above and beyond basic Residency and Creation Fund costs. Expenses may include salaries and wages, consultants/honoraria, artists fees, planning costs, production costs, administrative costs, evaluation/documentation, etc.

Expenses

/ Describe / Amount
$
$
$
$
$
$
$
$
TOTAL EXPENSES / $
Income
/ Describe ( “pending,” received”, etc.) / Amount
NPN Community Fund / This request (up to $6,000) / $
Other Cash Sources / $
TOTAL INCOME / $
/ Describe (space, materials, cash value, etc.)
IN-KIND RESOURCES

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