EmailMe Form - CAIP 2018 Individuals/Collectives Self Evaluation

EmailMeForm

Self-Evaluation Forms must be completed and submitted with your 2019 CAIP Investment Request Application (Monday, April 15, 2019 by 4:00 p.m.) OR no later than Friday, April 19, 2019 by 4:00 p.m. if you are not applying to the 2019 grant cycle.
Recipient Information
Recipient Name *
Individual or Name of Collective to whom Investment cheque was written
Contact Person if Applicant is a Collective
First Last
Position Held by Contact Person
Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone 1 *
### - ### - ####
Phone 2
### - ### - ####
Email *
Web Site
Area of the Arts *
Dance/ Theatre/ Performance Arts
Film/ Digital Arts
Literature
Music
Visual Arts
Self Evaluation
2018 CAIP Reconciled Budget (.xls .xlsx) *
2018 CAIP RECONCILED BUDGET: Please ensure you use the format we provide. Your budget report must balance at zero (expenses = revenues).
Summarize the project you completed by providing a brief description of the activities you undertook. *
(500 words or less)
Describe the impact of your project on the following areas: *

Your Artistic Development

General Community

(300 words or less for each field)
List any non-artist community collaborations or partnerships, if applicable
(250 words or less) Name and brief description of the nature of the collaboration or partnership.
Total Number of collaborations/partnerships
Community Involvement

Number of Volunteers (if applicable)

Audience Numbers

Number of Presentations (ie. number of concerts, theatre productions or number of exhibition days)
Advertisements, Marketing & Promotion Tools You Used *
Newspaper
Television
Radio
Posters
Postcards
Website
Email
Facebook
Twitter
Instagram
Other
if you checked "Other", please specify.
Media Coverage

Newspaper

Television

Radio

Social Media (Twitter, Facebook etc.)
Explain how you acknowledged the investment you received from London Arts Council and City of London *
(200 words or less)
Additional Comments
(200 words or less)
DECLARATION
2018 CAIP DECLARATION_SELF EVALUATION: Please ensure you read the content of the Declaration and put your signature/date before you upload.
Name *
First Last
Individual Artist or Artist Collective Lead
Declaration (.pdf .doc .docx .jpg .jpeg) *
The Self-Evaluation Form must be completed and submitted with a CAIP 2019 application (Monday, April 15, 2019 by 4:00 p.m.) or no later than Friday April 19, 2019 by 4:00 p.m. if you are not applying to the 2019 grant cycle.

If you have any inquiries regarding your CAIP application, please contact:

Rebekah Morrison-Wize
Development Officer, Investments
rmorriso@london.ca

London Arts Council
201 King Street London ON N6A 1C9
519.439.0013 ext. 5064
www.londonarts.ca

Number of Volunteers (if applicable)
Audience Numbers
Number of Presentations (ie. number of concerts, theatre productions or number of exhibition days)

Newspaper
Television
Radio
Social Media (Twitter, Facebook etc.)

Your Artistic Development
General Community

Recipient Information

Self Evaluation

DECLARATION