EmailMe Form - Allocation Request Form

Allocation Request Form | Fund for the Arts

Information will be used by the Allocation Committee of the Fund for the Arts (FFA) to process the funding request for your organization. Please contact the Allocation Committee with any questions related to the application process.

The Allocations Application must be completed each year by September 30. Fund for the Arts will send you email notification that your Allocations Application has been received. Allocation checks are issued during the second week of January.

Organization Name *
Person Completing Form *
Organization Primary Contact *
First Last
Contact Title
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *
Phone
### - ### - ####
Web Site
Financial Information
Please provide financial information for most recently completed fiscal financial period. Budget Information should be provided for the upcoming fiscal period.
Fiscal Year End *
MM / DD / YYYY

Financial Position

	Current	Prior Year
Cash
Receivables, net of allowance
Other Current Assets **
Investments
Other Non-Current Assets **
Fixed Assets, net
Accounts Payable
Other Short-Term Liabilities **
Long-Term Liabilities
Equity \| Net Assets

Financial Results

	Current	Prior Year	Budget
Donation & Fundraising
Ticket Sales
Cost of Productions
Salary & Benefits
Utilities & Office Costs
Professional Fees (attorney, CPA, etc)
Advertising \| Promotion Fees

** - Other Item Discriptions
Please provide a brief description of other categories (ie other assets or other liabilities)

Revenue from Solicitations Of Businesses, Foundations, or Government Agencies

	Name	Source (Business, Foundation or Govt Agency)	Cash Amount / Description of In-Kind Donation	Purpose of Solicitation (event, capital campaign or endowment)	FFA Approval Date
Revenue Source #1
Revenue Source #2
Revenue Source #3
Revenue Source #4
Revenue Source #5

Revenue Sources (additional notes)
Please use this area to disclose additional revenue solicited from businesses, foundations or government agencies. At least 90% of all non-ticket revenue solicited from businesses, foundations or government agencies should be disclosed.
Officers & Directors
Name Phone E-Mail

President

Vice President

Secretary

Treasurer

Board Member

Board Member

Board Member

Board Member

Board Member
Additional Board Members
Pease use this field to list remaining board members.
Current Fiscal Year | Program Data
Please provide summary information for programs offered by your organization for the most recent fiscal period. Additional discussion can be provided below.

	Program #1	Program #2	Program #3	Program #4	Program #5
Name of Program
Brief Description of Program
How many community members were served (directly or indirectly)?
Was local talent used (yes/no)?
What was the price of admission?
Was subsidy or assistance provided for admission?
How many paid employees/contractors were used?
How many volunteers were used during event?
Reach an audience that does not have reliable access to the arts? (please explain)
Was an important niche in the arts community in the Charleston metropolitan area fulfilled? (please explain)

Additional Program Information (Current Fiscal Year)
Please use the area above to provide additional information about programs offered.
Upcoming Fiscal Year | Program Data
Please provide summary information for programs your organization plans to offer in the upcoming fiscal year.
Upcoming Programs

Program #1 Program #2 Program #3 Program #4 Program #5

Program Name

Description of Program

Date of Event

Location of Event
Additional Program Information (Upcoming Fiscal Year)
Please use the area above to provide additional information about programs offered.
Policy Acknowledgements
The FFA's allocation of funding to your organization is based on (1) community support of your organization, (2) financial responsiblity of your organization, (3) financial need of your organization, (4) minimum program standards, and (5) such other factors as determined by the Allocations Committee from time to time.

See Bylaws of Fund for the Arts, Article IX, Sec 9.1

Please indicate acknowledgements of policies by checking respective boxes.
*
Has the Beneficiary Agency reviewed FFA's Policy on independent Fund-Raising from Businesses, Busineses Foundations, and Local Governments by Beneficiary Agencies ("Independent Fund-Raising Policy") and complied with its terms?
Has the Beneficiary Agency reviewed Fund for the Art's last-published annual list of donors, available at http://www.fundfortheartswv.org/sponsors.php ?
Has the Beneficiary Agency refrained altogether from soliciting from businsses, foundations, and government during the months of February, March, and April, the period during which FFA conducts its major, direct fundraising efforts on the Beneficiary
Has the Beneficiary Agency refrained from soliciting support from FFA's donors except with prior approval by FFA, which may be given for special projects, capital improvement, or endowment funds?
With respect to funds solicited for special events or projects during the reporting year, did the Beneficiary Agency provide to FFA in its request to proceed information about the events?
With respect to the funds solicited for capital improvements or endowment fund purposes during the reporting year, did the Beneficiary Agency provide to FFA dates and usage of requested funding
Has the Beneficiary Agency reported to FFA in this application all contributions received during the reporting year from businesses, foundations, and government agencies?
Has the Beneficiary Agency reported to FFA in this application all in-kind contributions of materials, supplies, furniture, equipment, fixtures, or services it received during the reporting year?
Has the Beneficiary Agency displayed prominently on all printed materials the logo of Fund for the Arts?
Has the Beneficiary Agency included in each of its programs an advertisement acknowledging the gifts of contributions which donated more than $10,000 to FFA the year before the reporting year?
File Upload
Please upload most recent financial statements and other relevant information to aid the allocation committee's evaluation of your organization.
Certification *
Clear
Please certify information provided above. President or equivalent should certify.

	Name	Phone	E-Mail
President
Vice President
Secretary
Treasurer
Board Member
Board Member
Board Member
Board Member
Board Member

Financial Information

Officers & Directors

Current Fiscal Year | Program Data

Upcoming Fiscal Year | Program Data

Policy Acknowledgements