Marion Cultural Alliance

ORGANIZATION APPLICATION COVER PAGE

Applicant Name*

(Legal Name of Not-For-Profit-Entity)

Type of Funding*

Check one type of funding. Additional checkbox will appear below this form after your choice.

General Program Support
Special Project
Organizational Development

Special Project - select one component below*

Artist in Residence
Festival
Special Exhibits
Special Events

Organizational Development - select one component below*

Consultant
Support Services

NOT-FOR-PROFIT DESIGNATION

I hereby certify that the above referenced applicant is eligible to receive grants from the Marion Cultural Alliance pursuant to the following not-for-profit status of organization (CHECK #1, #2 or #3).

Not-For-Profit-Designation*

A public entity governed by a county municipality, school district, community college, college, university, or an agency of state government.
A not-for-profit, tax exempt Florida corporation incorporated or authorized as a not-for-profit corporation in good standing pursuant to Chapter 617, Florida Statues (Chapter 623, FS. For private schools.)
Designated as a tax-exempt organization as defined in Section 501 (c) (3) or (4) of the Internal Revenue Code of 1954.

Certification of Not-For-Profit Status

Please upload a copy of Certificate of Florida Not-for-Profit Status, or a copy of IRS determination letter for federal tax-exempt status as applicable.

Accepted file types: jpg, gif, png, pdf, doc, docx, txt, rtf, html, odt, jpeg, Max. file size: 128 MB.

CERTIFICATION

I certify that the information contained in this application, including all attachments and support materials is true and correct to the best of my knowledge and that I will abide by all legal, financial, and reporting requirements, such as matching funds and final reports for all grants received by the organization.

Typed Name of Authorizing Official:*

Title of Authorizing Official:*

Telephone Number:*

Date Signed:*

General Information

IDENTIFICATION

Applicant (legal name of organization as shown on IRS 501 (c)(3) or (4)*

Applicant Name Continued (dba, department, etc.):

Address (mailing):*

Address (street):*

City:*

Zip Code: (street)*

Federal Identification Number (FEID):*

Resident County of Applicant:*

Telephone (Area Code/Number):*

Fax Number:

Contact Person: (Please indicate)

First Name:*

Last Name:*

Email Address of Contact Person:*

Date of Incorporation:*

Website Address*

Type of Organization*

Arts
Non-Arts

Applicant's Fiscal Year Dates (Month/Day)*

FROM:

Applicant's Fiscal Year Dates (Month/Day)*

TO:

Has your organization ever received a grant from the Marion Cultural Alliance?*

Yes
No

Has your organization submitted a Final Report?*

Yes
No

Please Note - If a Final Report for your previous Grant has not been filed, your current application will not be accepted.

Year Last Received:*

PROPOSAL INFORMATION

Proposal Title:*

Grant Amount Requested:*

Start Date: (Month Day, Year)*

End Date: (Month Day, Year)*

Number of Different Events:*

Number of Individuals Expected to Participate in the Proposal Activities:*

Number of Youth Participating in the Project:*

Total Number of Opportunities to Participate:*

Total Number of Artists Participating in the Project:*

ORGANIZATION MISSION STATEMENT*

In the space below, please provide the mission statement of your organization (or program mission, if applicable.)

PROPOSAL SUMMARY

Describe Your Proposed Project or Program:*

Describe your proposed project or program. Identify your goals and how you plan to achieve them. Be specific!

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PROPOSED BUDGET AND REVENUE SOURCES

Describe the operating expenses for the program (salaries, marketing costs)

The requested grant amount may not exceed 50% of the anticipated total expenses, describe other funding sources, in addition to this grant that you anticipate will support the expenses.

What other funding sources, besides this grant, do you anticipate to support the expenses of this program/project? Describe the donations (both cash and non-cash) that your organization receives from the community. Describe admission charges, if applicable

Be sure to complete the budget form in detail

Round amounts to the dollar - do not show cents. Double check arithmetic. This budget must balance.* (Note: In-Kind contributions may not exceed 25 percent of the proposal costs.)

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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Admissions*

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Contracted Services Revenue*

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Contracted Services Revenue*

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Other Revenue*

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Corporate Support*

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Foundation Support*

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Other Private Support*

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Government Support - Federal*

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Government Support - State/Regional*

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Applicant Cash (Savings, Reserves, Etc.)*

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MCA Grant*

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Cash Match*

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In-Kind Contributions*

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B. Total In-Kind Contributions*

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C. Total Proposal Costs (Total of MCA Grant, Cash Match + In-Kind)*

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D. Total Cash Income*

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E. Grant Amount Requested*

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F. Total Cash Income (D+E)*

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G. Total In-Kind Contributions (Repeat Amount Listed in (B))*

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H. Total Project Income (Must Equal C)*

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I. Percentage of Total Project (Box C) Requested From MCA*

Anti-Discrimination Policy*

Our organization has an Anti-Discrimination Policy and abides by it.

Yes

Does your organization have a Cultural Equity Policy?*

Yes
No

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Apply

Step 1: MCA Cultural Grants Application

ORGANIZATION APPLICATION COVER PAGE

NOT-FOR-PROFIT DESIGNATION

CERTIFICATION

General Information

IDENTIFICATION

PROPOSAL INFORMATION

PROPOSAL SUMMARY

PROPOSED BUDGET AND REVENUE SOURCES

Address

Hours of Operation:

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