Audience Access Grants Program Application
Program Administrator: Francine M. Andersen
111 NW 1st Street, Suite 625 w Miami, FL 33128
Phone: (305) 375-5024 w Fax: (305) 375-3068
Email: / Audience Access Grants Program
APPLICATION INFORMATION
(1) Application Submission Date:
Organization and Grant Contact Information
(2) Organization’s Legal Name
(exactly as it appears on Articles of Incorporation):
(3) DUN & BRADSTREET D-U-N-S # (for more info contact www.DNB.com)
(4) FEI#: - / (5) Year of Incorporation:
(6) Application Contact: / Mr. / Mrs. / Ms. / Miss / Dr.
Contact Title: / Phone (day): () - ext.
Legal Address: / Phone (other): () - ext.
Fax: ( ) -
City: / State: FL / Zip: / Email:
(7) Organization website:
(8) Organization’s ADA/Access Coordinator:
PROJECT / EVENT Information
(9) Project / Event Date(s):
(10) Project / Event Location/Venue(s):
(11) Municipality in which project activities will take place
(use codes): / Primary: # / Secondary: #
01 Miami
02 Miami Beach
03 Coral Gables
04 Hialeah
05 Miami Springs
06 North Miami
07 North Miami Beach / 08 Opa-Locka
09 South Miami
10 Homestead
11 Miami Shores
12 Bal Harbour
13 Bay Harbor Island
14 Surfside
/ 15 West Miami16 Florida City
17 Biscayne Park
18 El Portal
19 Golden Beach
20 Pinecrest
21 Indian Creek Village / 22 Medley
23 North Bay Village
24 Key Biscayne
25 Sweetwater
26 Virginia Gardens
27 Hialeah Gardens
28 Aventura / 29 Islandia
30 Sunny Isles Beach
31 Miami Lakes
32 Palmetto Bay
33 Miami Gardens
34 Doral
35 Cutler Bay
99 Unincorporated
(12) Miami-Dade Commission District: # / Florida State Senate District: #
Florida State House District: # / U.S. Congress District: #
(Please call the Miami-Dade County Elections Board at (305) 375-4600 for assistance with district information, or visit www.miamidade.gov for county district information, www.myflorida.com for State district information, and www.house.gov for US Congress information.)
PROJECT / EVENT PARTICIPATION
(13) Primary Audience:
(check only one) / White, Not Hispanic / Hispanic / Caribbean / General
(no specific emphasis)
Black, Not Hispanic / Asian / Other (Specify):
(14) Other Population(s)
to be served:
(check one or more only if applicable) / Minorities / At-Risk Youth / Children with Disabilities
Adults / Seniors
(15) Numbers of Children to be Served:
Attending, Participating Performing COMBINED / # of Infants / Preschool (Ages 0-5)
# of Children (Ages 6-12)
# of Youth (Ages 13-18)
Note: only young adults with disabilities
ages 19-22 are to be counted here: / # of Young Adults (Ages 19-22)
Total # - All Ages:
# of Children/Youth with Disabilities
(16) TOTAL PARTICIPATION:
All Adults PLUS All Children Combined: / Audience/Attending: / Performing/Instructing:
PROJECT Synopsis / USE OF COUNTY FUNDS
(17) GRANT AMOUNT REQUESTED: $
(Amount not to exceed $1,000)
(18) Describe your project / event and indicate how grant funds will be used to achieve ADA/Programmatic Accessibility for your audience:
project budget
(19) EXPENSES (e.g. ASL Interpreter fees, ADA Consultant Fees, etc.): / Amount
$
$
$
$
$
Note: Total Project Budget Expenses must be equal to
Total Project Budget Revenues. / TOTAL EXPENSES: / $
(20) REVENUES:
a) Secured Revenues (e.g. other grants support already received, foundation support, cash on hand, etc.):
Identify Sources below (attach additional sheet if necessary): / Amount
$
$
$
b) Unsecured/Proposed Revenues (e.g. pending grants, other planned fundraising efforts, etc.):
Identify Sources below (attach additional sheet if necessary): / Amount
$
$
$
TOTAL CASH MATCH (a+b): / $
c) Audience Access Grant (amount being requested from this grant) / $
(maximum $1,000)
Note: Total Project Budget Expenses must be equal to
Total Project Budget Revenues. / TOTAL REVENUES (a+b+c): / $
Certification/Signature
I certify that all information contained in this application and attachments is true and accurate. No County employee shall be signatory on behalf of an organization requesting funds from the Department of Cultural Affairs. All funded activities must provide equal access and equal opportunity in employment and services and may not discriminate on the basis of disability, color, creed or religion.
AUTHORIZING SIGNATURE / DATE
TYPED/PRINTED NAME / TITLE
application CHECKLIST
Submit the following items to support your application:
One (1) SIGNED ORIGINAL completed Audience Access Application Form.
Current Miami-Dade County Department of Cultural Affairs ADA Survey (download survey at http://www.miamidadearts.org/ada.aspx ).
Estimate(s), invoice(s), purchase orders, or contract(s) for ADA/Accessible service(s) or item(s) to be purchased.
GRANT PAYMENT CHECKLIST
Funded projects will be paid on a reimbursement basis.
To request payment, the following items must be submitted:
A one-page summary describing your project / event and how the Audience Access grant was used to achieve ADA/Programmatic Accessibility for your audience.
Paid invoice(s) / receipt(s) for ADA/Accessible service(s) or item(s) purchased.
Proof of payment for service(s) or item(s) purchased (cancelled checks, bank issued proof of payment, etc.).
Up to three (3) project / event support documents (program, advertisements, flyers, etc.).
submit application and grant payment requests to:
Francine M. Andersen, Chief of Arts Education
Miami-Dade County Department of Cultural Affairs
111 NW 1st ST, Ste. 625
Miami, FL 33128
Ph: (305) 375-5024
All funded activities must provide equal access and equal opportunity in employment and services, and may not discriminate on the basis of race, color, religion, ancestry, national origin, sex, pregnancy, age, disability, marital status, familial status, sexual orientation or physical ability, in accordance with Title VI and Title VII of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 as amended (42 U.S.C. 2000d et seq.), the Americans with Disabilities Act (ADA) of 1990, Section 504 of the Rehabilitation Act of 1973, and Miami-Dade County ordinances No. 97-170, § 1, 2-25-97 and No. 98-17, § 1, 12-1-98.
The Grantee must include the following credit line in all promotional and marketing materials related to this grant including web sites, news and press releases, public service announcements, broadcast media, event programs, and publications: “With the support of the Miami-Dade County Department of Cultural Affairs and the Cultural Affairs Council, the Miami-Dade County Mayor and Board of County Commissioners.” The grantee must also use the Department’s logo in marketing and publicity materials whenever possible. Please call the Department to request an electronic logo file or download it from our website (www.miamidadearts.org). Grantees are required to recognize and acknowledge Miami-Dade County’s grant support in a manner commensurate with all contributors and sponsors of its activities at comparable dollar levels.
Miami-Dade County provides equal access and equal opportunity in employment and services and does not discriminate on the basis of race, color, religion, ancestry, national origin, sex, pregnancy, age, disability, marital status, familial status, sexual orientation or physical ability, in accordance with Title VI and Title VII of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 as amended (42 U.S.C. 2000d et seq.), the Americans with Disabilities Act (ADA) of 1990, Section 504 of the Rehabilitation Act of 1973, and Miami-Dade County ordinances No. 97-170, § 1, 2-25-97 and No. 98-17, § 1, 12-1-98.
The Miami-Dade County Department of Cultural Affairs and the Cultural Affairs Council develop cultural excellence, diversity and participation throughout Miami-Dade County by strategically creating and promoting opportunities for artists and cultural organizations, and our residents and visitors who are their audiences. The Department directs the Art in Public Places program and its board, the Art in Public Places Trust, commissioning, curating, maintaining and promoting the County’s art collection. Through staff, board and programmatic resources, the Department, the Council and the Trust promote, coordinate and support Miami-Dade County’s more than 1,000 not-for-profit cultural organizations as well as thousands of resident artists through grants, technical assistance, public information and interactive community planning. The Department receives funding through the Miami-Dade County Mayor and Board of County Commissioners, the Children’s Trust, the National Endowment for the Arts and the American Recovery and Reinvestment Act of 2009, the State of Florida through the Florida Department of State, Division of Cultural Affairs and the Florida Arts Council, and the John S. and James L. Knight Foundation. Other support and services are provided by Ticketmaster for the Culture Shock Miami program, the Greater Miami Convention and Visitors Bureau, the South Florida Cultural Consortium and the Tourist Development Council.
Audience Access Grants Program Application Page 1 of 4 (Revised 11.4.09) AUD