Council for the Arts Grants Program

Council for the Arts at MIT
Grants Program
Application Form

Please read the Grants Program Guidelines before completing this application form and guidelines checklist. All sections must be completed. If you have any questions, please call 617/253-4005 or send e-mail to cohen@media.mit.edu.

Name:

MIT Address:

Telephone Number:

Grant Amount Requested:

E-mail Address:

Project Title:

Project Start Date:

Faculty Advisor:

Project Location:

Project End Date:

Project Description:

Please descibe how this project will involve the MIT community:

Itemized Expenses

Note: For each item, and for the total, the total of the funding and contributions should equal the amount needed.

List all project expenses below (materials/equipment/fees/publicity/etc.):

Amount:

Amount Requested from
the Council for the Arts:

Cash contributions*
(list source and amount):

In-kind contributions*
(list source and
estimated value):

Total:

Total Project Cost:

Total Funding Sought + Potential Contributions:

* If cash or in-kind contributions are not yet approved, please indicate with an asterisk.

Check this box if you have more itemized expenses than fit in the above table. If this is the case, you will need to submit these on a piece of paper separately to the Council for the Arts office (E15-205) or email it to cohen@media.mit.edu.

The budget prepared above represents a current assessment of project expenses and contributions. Within one month of the project's completion, I will submit to the Council for the Arts a final report and financial statement, including copies of receipts equal to the grant amount.

I have read and agree to this statement.

Date:

Please complete this checklist. Your application cannot be
submitted unless you complete the checklist below.

	I have read the Grants Program guidelines and understand the application review procedures.
	I agree to provide supporting material by the deadline date of the funding cycle. Certain kinds of supporting material will be photocopied for advance distribution to Grants Committee members. I will also provide other material for the "site visit" with Grants Committee members.
	I agree to be available from 9:00-11:00am for a scheduled site visit on the review date of the funding cycle. If this is not possible, I will notify the Council staff who may arrange another appointment.
Date: