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2018 Allocations Application | Fund for the Arts
The Screening and Allocations Committee ("S&A Committee") of Fund for the Arts ("FFA") will process your funding request. Please contact the Chair of the S&A Committee or your Board liaison with any questions relating to this process. Executive Director Margaret Lieberman (artsfundwv@frontier.com or 304-345-0775) can provide names and contact information.
Arts groups must complete an Allocations Application each year by September 30. The S&A Committee Chair will send an email confirmation of receipt. FFA issues checks during the second week of January.
Organization Name
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Person Completing Form
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First
Last
Organization's Primary Contact
*
First
Last
Primary Contact's Title
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Email
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Confirm email (require)
Phone
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Web Site
Financial Information
Please provide financial information for your most recently-completed fiscal financial period. Please provide budget information for the upcoming fiscal period.
Fiscal Year End
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MM
/
DD
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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 Descriptions
Please provide a brief description of other categories (i.e., other assets or 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 Datea
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. You must disclose at least 90% of all non-ticket revenue solicited from businesses, foundations, or government agencies.
Officers & Directors
Name
Phone
Email
President
Vice President
Secretary
Treasurer
Board Member
Board Member
Board Member
Board Member
Board Member
Additional Board Members
Current Fiscal Year | Program Data
Please provide summary information for programs offered by your organization for the most recent fiscal period. You may provide additional detail below.
Program #1
Program #2
Program #3
Program #4
Name of Program
Brief Description of Program
How many community members were served (directly or indirectly)?
Did you use local talent (yes/no)?
What was the price of admission?
Did you offer any subsidies or assistance for admission?
How many paid employees/contractors did you use?
How many volunteers did you use?
Did you reach an audience that lacks reliable access to the arts? (please explain)
Did you fill an important niche in the metro-area arts community? (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 during the upcoming fiscal year.
Upcoming Programs
Program #1
Program #2
Program #3
Program #4
Program Name
Program Description
Program Date
Progam Location
Additional Program Information (upcoming year)
Please use the area above to provide additional information about programs offered.
Policy Acknowledgements
FFA's allocation of funding to your organization is based on (1) community support of your organization, (2) financial responsibility of your organization, (3) financial need of your organization, (4) minimum program standards, and (5) such other factors the S&A Committee may establish from time to time.
See Bylaws, 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, Business 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://fundfortheartswv.org/sponsors ?
Has the Beneficiary Agency refrained altogether from soliciting from businesses, foundations, and government during the months of February, March, and April, the period during which FFA conducts its major, direct fundraising efforts?
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 improvements, 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 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 contributors who donated more than $10,000 to FFA the year before the reporting year?
File Upload
Please upload your most recent financial statements and any other relevant information that might aid the S&A Committee's evaluation of your application.
Certification
*
Please certify information provided above. (President or equivalent should certify.)